Eight-Year Comparative Outcomes Of Ultrathin Dsaek And Dmek
Published 2026 - 44th Congress of the ESCRS
Reference: FP14.01 | Type: Free paper | DOI: 10.82333/k3sh-6603
Authors: Dr Linda Marie Louise Busin* 1 , Dr Angeli Christy Yu 2 , Prof. Dr Massimo Busin 2
1Department of Ophthalmology,Ospedali Privati Forlì,Forli,Italy, 2Department of Translational Medicine,University of Ferrara,Ferrara,Italy;Department of Ophthalmology,Ospedali Privati Forlì,Forli,Italy
Purpose
To compare 8-year visual, endothelial, and graft survival outcomes of ultrathin Descemet stripping automated endothelial keratoplasty (DSAEK) and Descemet membrane endothelial keratoplasty (DMEK) in eyes with endothelial decompensation secondary to pseudophakic bullous keratopathy (PBK) and Fuchs endothelial corneal dystrophy (FECD).
Setting
Tertiary Eye Care Referral Center (Ospedali Privati Forlì “Villa Igea”, Forlì, Italy).
Methods
In this comparative retrospective interventional case series, medical records of patients who underwent ultrathin DSAEK or DMEK between January 2015 and December 2017 for PBK or FECD were reviewed. Best spectacle-corrected visual acuity (BSCVA), endothelial cell density (ECD), immune rejection and graft survival rates were analyzed up to 8 years. Kaplan–Meier survival analysis was used to estimate cumulative graft survival and rejection probability.
Results
Results from 147 cases of ultrathin DSAEK and 185 DMEK are reported in this analysis. Eight-year BSCVA ≥20/20 was achieved in 56.8% (ultrathin DSAEK) and 61.2% (DMEK); BSCVA ≥20/40 was 96.4% and 97.1%, respectively (all p>0.05). After the second year, no significant differences in visual acuity were observed between groups at any time point. Mean endothelial cell loss at 8 years was significantly higher after DMEK than ultrathin DSAEK. Kaplan–Meier analysis showed that at 8 years, the cumulative probability of immune rejection was 9% after ultrathin DSAEK and 6% after DMEK, with graft survival rates of 93% and 91%. Stratified analysis showed no significant differences between PBK and FECD in any outcome for either surgical technique.
Conclusions
At 8 years, ultrathin DSAEK and DMEK demonstrated comparable long-term visual acuity and graft survival in eyes with PBK and FECD. No significant differences in visual outcomes were observed beyond the second postoperative year. Although endothelial cell loss was significantly higher after DMEK, graft survival rates remained comparable. Longer-term follow-up is required to determine whether the higher ECL translates into clinically meaningful differences in outcomes.