Ultrathin Descemet Stripping Automated Endothelial Keratoplasty (Ut-Dsaek) Versus Descemet Membrane Endothelial Keratoplasty (Dmek) In Eyes With Dsaek Graft Failure
Published 2025 - 43rd Congress of the ESCRS
Reference: PO513 | Type: Free paper | DOI: 10.82333/3pfn-1p70
Authors: Mireia García Bermúdez* 1 , Marco Antonio Pascual Santiago 1 , Patricia Robles Amor 1 , Javier García Bardera 1 , Alma San José Caballero 2 , Jose María Martínez de la Casa 1 , Laura Morales Fernández 1 , Julián García Feijoo 1
1Ophthalmology,Hospital Clínico San Carlos,Madrid,Spain, 2Ophthalmology,Consorci Sanitari de Terrassa ,Terrassa,Spain
Purpose
To compare the clinical outcomes of ultrathin Descemet stripping automated endothelial keratoplasty (UT-DSAEK) and Descemet membrane endothelial keratoplasty (DMEK) in patients with DSAEK graft failure.
Setting
Patients underwent keratoplasty at the department of ophthalmology of “Villa Igea”, Ospedali Privati Forlì (Forlì, Italy) between September 2011 and January 2024.
Methods
This is a retrospective review of prospectively collected data of consecutive patients who experienced DSAEK graft failure and subsequently underwent UT-DSAEK (n=56, 47.9%) or DMEK (n=61, 52.1%). Primary outcomes were best spectacle-corrected visual acuity (BSCVA), endothelial cell density (ECD), and immunological rejection rate. Kaplan-Meier analysis was performed to compare survival cumulative probability between the two groups.
Results
Mean preoperative BSCVA was 0.80±0.12 LogMAR for UT-DSAEK and 0.81±0.18 LogMAR for DMEK (P=0.73). There was no significant difference in BSCVA between the 2 groups, both 3 months (P=0.60) and 12 months after surgery (0.24±0.22 vs 0.25±0.24 LogMAR, P=0.79). Mean preoperative ECD was 2496±157 cells/mm2 and 2516±133 cells/mm2, respectively for UT-DSAEK and DMEK (P=0.49). Mean ECD for UT-DSAEK was significantly higher 2 years after surgery (1333±416 vs 1063±541 cells/mm2, P=0.02), but not after 5 years (941±501 vs 754±288 cells/mm2, P=0.33). Immune graft rejection occurred in 8 eyes (14.3%) after UT-DSAEK and in 3 eyes (4.9%) after DMEK (P=0.16). Graft survival rates at 5 years were 69.6% and 75.4% (P=0.83), respectively for UT-DSAEK and DMEK.
Conclusions
UT-DSAEK and DMEK achieved similar postoperative BSCVA and graft survival rates in eyes treated for DSAEK graft failure. Although UT-DSAEK showed higher ECD compared to DMEK after 2 years, this advantage was not maintained at later postoperative times.