ESCRS - P096 - COMBINED OR SEQUENTIAL DMEK IN CASE OF CATARACT AND GUTTAE – A SYSTEMATIC REVIEW AND META-ANALYSIS

COMBINED OR SEQUENTIAL DMEK IN CASE OF CATARACT AND GUTTAE – A SYSTEMATIC REVIEW AND META-ANALYSIS

Published 2023 - 27th ESCRS Winter Meeting

Reference: P096 | Type: Free Paper Submission | DOI: 10.82333/qc9f-x627

Authors: Maria Laura Passaro* 1 , Gianni Virgili 2 , Ciro Costagliola 1 , Francesco Semeraro 3 , Vito Romano 3

1Department of Neurosciences Reproductive and Dentistry Sciences,University of Naples Federico II,Naples,Italy, 2Dipartimento di Neuroscienze, Area del Farmaco e Salute del Bambino (NEUROFARBA),University of Firenze,Firenze,Italy, 3Dipartimento di Specialità Medico-Chirurgiche, Scienze Radiologiche e Sanità Pubblica,Università degli Studi di Brescia,Brescia,Italy

Purpose

To compare the outcomes of Descemet’s membrane endothelial keratoplasty (DMEK) performed after phacoemulsification (sequential DMEK) and DMEK combined with phacoemulsification (combined DMEK) in patients with coexisting Fuchs endothelial corneal dystrophy (FECD) and cataract.

Setting

Systematic literature review and meta-analysis. The review was performed according to the PRISMA guidelines and registered in PROSPERO.

Methods

Literature searches were conducted in Medline and Scopus. No restrictions on the date, language, or publication status were set. Studies reporting sequential DMEK and combined DMEK in FECD patients were included. The main outcome measure of the study was the corrected distance visual acuity (CDVA) improvement. Secondary outcomes were postoperative endothelial cell density (ECD), primary graft failure rate and graft detachment with rebubbling rate. Bias risk was assessed and a quality appraisal of the body of evidence was completed.

Results

A total of 667 eyes were included in this review, 292 eyes (43,77%) underwent a combined DMEK surgery, while 375 (56,22%) eyes underwent a sequential DMEK surgery. CDVA improvement, postoperative ECD, primary graft failure rate and rebubbling rate were compared with a metanalysis, showing no statistically significant difference between two groups (p = 0,19, p = 0,35, p = 0,86 and p = 0,89 respectively). Test for heterogeneity revealed substantial heterogeneity between studies, with an I2 statistics of 67,07%, t2 of 11210,87 and H2 of 3,04 for postoperative ECD; moderate heterogeneity for rebubbling rate with I2 of 47,51%, t2 of 0,15 and H2 of 1,91 and low heterogeneity for CDVA improvement with I2 statistics of 0%, t2 of 0 and H2 of 1,00 and for primary graft failure rate with I2 of 0%, t2 of 0 and H2 of 1,00.

Conclusion

The overall quality of the analysed studies is low, and randomized controlled trial (RCT) are needed. The data showed no difference in terms of CDVA improvement, postoperative ECD, primary graft failure rate and rebubbling rate between the two arms.