Comparative Analysis Of Clinical Outcomes In Preloaded Versus Surgeon-Loaded Descemet Membrane Endothelial Keratoplasty

To investigate clinical outcomes between preloaded and surgeon-loaded grafts in descemet membrane endothelial keratoplasty (DMEK).

A literature review and meta-analysis.

A literature search was conducted on Pubmed and Embase to identify studies comparing outcomes of preloaded versus surgeon-loaded DMEK grafts. Primary outcomes included endothelial cell loss (ECL) and corneal thickness change at postoperative time points (1, 3, 6, and 12 months), with the rebubbling rate as a secondary outcome. Standardized mean differences (SMD) for primary outcomes and relative risk (RR) for the secondary outcome were calculated and pooled using random-effects models.

Six peer-reviewed articles comprising 1167 eyes were included. Of these, 556 eyes received preloaded grafts, and 611 received surgeon-loaded grafts. The overall SMD for ECL comparing preloaded to surgeon-loaded DMEK was 0.19 (95% CI, -0.02 to 0.40), and for corneal thickness change, it was -0.13 (95% CI, -0.23 to -0.03). Rebubbling occurred in 16.7% of preloaded and 17.5% of surgeon-loaded grafts, with an overall RR of 0.85 (95% CI, 0.52 to 1.39).

While surgeon-loaded grafts showed superiority in ECL and corneal thickness change compared to preloaded grafts, differences were not statistically significant. Conversely, preloaded DMEK had a lower rebubbling rate, though not statistically significant. Further investigation requires randomized controlled trials with larger sample sizes.