Eye-Bank Precut Versus Surgeon-Cut Tissue Graft For Descemet Stripping Automated Endothelial Keratoplasty (Dsaek): A Systematic Review And Meta-Analysis
Published 2024 - 42nd Congress of the ESCRS
Reference: PO736 | Type: Poster | DOI: 10.82333/pkh2-ps41
Authors: Abdulmalik Omar Alsaif* 1 , Mohammad Karam 2 , Alhanoof Almekhlef 3 , Khaldon Abbas 4 , Khaled Alkandari 3 , Dalal Alroumi 3 , Abdulrahman Alotaibi 3 , Siddharth Nath 2 , Samir Jabbour 5
1King Khaled Eye Specialist Hospital (KKESH),Riyadh,Saudi Arabia;Royal Eye Unit,Kingston Hospital,London,United Kingdom;Moorfields Eye Hospital,London,United Kingdom, 2Department of Ophthalmology & Visual Sciences,McGill University,Montreal,Canada, 3AlBahar Eye Center,Ibn Sina Hospital,Kuwait,Kuwait, 4Medicine,University of British Columbia,British Columbia,Canada, 5Department of Ophthalmology & Visual Sciences,McGill University,Montreal,Canada;Department of Ophthalmology, Centre Hospitalier de l'Université de Montréal (CHUM),Montreal,Canada
Purpose
The purpose of this study is to compare the outcomes of eye-bank precut versus surgeon-cut tissue graft for patients undergoing Descemet Stripping Automated Endothelial Keratoplasty (DSAEK).
Although several comparative studies have been published to compare the two preparations, this is the first systematic review and meta-analysis in the literature to amalgamate the data of these studies to evaluate their effectiveness.
Setting
This is a systematic review and a meta-analysis of the existing literature on the topic.
Methods
A systematic review and meta-analysis were performed as per the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) Guidelines. A search of electronic information was conducted to identify all comparative studies of eye-bank precut versus surgeon-cut tissue graft for DSAEK. Endothelial cell loss (cells/mm²), rebubbling rate and best corrected visual acuity (BCVA) were primary outcome measures. Secondary outcome measures included postoperative corneal thickness (µm), complications and cost analysis. Fixed effects modelling was used for the analysis.
Results
Six studies with 548 DSAEK grafts were identified. At 1 year follow-up, a statistically significant difference in endothelial cell loss and post-operative BCVA favouring the eye-bank group were noted (MD= -4.53,P=0.02 and MD= -0.01,P=0.007, respectively). There was no significant difference between eye-bank precut and surgeon-cut graft groups in terms of rebubbling rate (Odds Ratio [OR] = 1.70, P = 0.25) and graft failure rate (OR= 1.04, P= 0.97). Similarly, no statistically significant difference was noted regarding postoperative corneal thickness and complications, including increased intraocular pressure and the development of Irvine-Gass Syndrome. Cost analysis demonstrated lower surgical expenses with the surgeon-cut tissue grafts.
Conclusions
Eye-bank is an excellent alternative to surgeon-cut tissue graft for patients undergoing DSAEK as it is associated with improved endothelial cell loss and BCVA and yields similar re-bubbling rate. Further studies with larger sample sizes should be conducted to draw a robust conclusion from the current findings.