Clinical Outcomes After Ultrathin Descemet's Stripping Automated Endothelial Keratoplasty Versus Descemet's Membrane Endothelial Keratoplasty For Fuchs Endothelial Corneal Dystrophy. A Systemic Review And Meta-Analysis.

In Fuchs' endothelial corneal dystrophy (FECD), the endothelial cell layer undergoes degenerative changes, and the cells are reduced in number. By 2050, the number of people affected by FECD is expected to grow by 41.7%. Descemet Membrane Endothelial Keratoplasty (DMEK) and Ultra-Thin Descemet Stripping Automated Endothelial Keratoplasty (UT-DSAEK) were two evolutionary surgical techniques both are indicated for the treatment of patients with FECD. This metanalysis aims to compare the postoperative clinical results of DMEK and UT-DSAEK for the treatment of adult patients with FECD.

We conducted a literature search through peer-reviewed electronic databases such as PubMed (MEDLINE), Cochrane Library, etc., last run-on 1 October 2022. Best corrected visual acuity (BCVA) served as our primary outcome measure. Endothelial cell density (ECD)and surgical complications were secondary outcomes.

Our literature search was conducted through peer-reviewed electronic databases such as PubMed (MEDLINE), Cochrane Library, Embase, and Google Scholar, last run on October 1, 2022, and followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) standards. The search strategy combined the keywords "DMEK" AND "UT-DSAEK.  

The PICOS scheme was created with the following factors: patients (P), adults worldwide who are male and female with FECD (I), UT-DSAEK performed in patients with FECD (C), DMEK performed in patients with FECD (O), efficacy and complications (S), randomized controlled trials (RCTs) and non-randomized comparable studies (NRSs).

Compared to UT-DSAEK, DMEK in cases of FECD may improve BCVA at one year (95% CI =0.339-0.913, p<0.001) with the greatest risk of re-bubbling (RR =0.280, p=0.020). There were no differences between the two surgical techniques in ECD at twelve months (SMD =0.172, p=0.640), where the overall risk of adverse events was 0,64 times higher in the DMEK group. (RR =0.645, 95% CI =0.435-0.956, p=0.029).

DMEK had better visual outcomes in terms of overall visual acuity compared to UT-DSAEK while presenting higher rates of total complications and graft detachment requiring re-bubbling. Although DMEK's complications are manageable, some do require additional surgical procedures. Nevertheless, both techniques are still efficacious options for a corneal surgeon regarding FECD patients.