Ten-Year Results Of Descemet Stripping Automated Endothelial Keratoplasty Versus Descemet Membrane Endothelial Keratoplasty
Published 2026 - 44th Congress of the ESCRS
Reference: FP14.07 | Type: Free paper | DOI: 10.82333/tnw7-5h14
Authors: Dr Andrea Taloni* 1 , Dr Raphael Kilian 1 , Dr Valentino de Ruvo 1 , Dr Nicolò Ciarmatori 1 , Dr Linda Marie Louise Busin 1 , Dr Rossella Spena 1 , Dr Andrea Sollazzo 1 , Dr Niccolò Salgari 1 , A/Prof. Cristina Bovone 1 , A/Prof. Massimo Busin 1
1Department of Translational Medicine and for Romagna,University of Ferrara,Ferrara,Italy
Purpose
To compare the long-term outcomes of Descemet stripping automated endothelial keratoplasty (DSAEK) and Descemet membrane endothelial keratoplasty (DMEK).
Setting
Patients underwent keratoplasty at the department of ophthalmology of “Villa Igea”, Ospedali Privati Forlì (Forlì, Italy) between January 2005 and December 2024.
Methods
This is a retrospective cohort study based on prospectively collected data. The main indications for surgery were Fuchs dystrophy (DSAEK 47%, DMEK 52%) and pseudophakic bullous keratopathy (DSAEK 32%, DMEK 22%). Patients were excluded if they underwent previous ocular surgery, except uneventful cataract surgery, or in case of pre-existing vision-impairing comorbidities. Primary outcomes were best-corrected visual acuity (BCVA), endothelial cell density (ECD), and endothelial cell loss (ECL), as well as rebubbling, graft survival, and graft immunologic rejection rates. Kaplan-Meier analysis was performed for graft survival and immunologic rejection. A biexponential regression model was used to predict the time for ECD to reach 500 cells/mm2.
Results
We included 1048 DSAEK and 294 DMEK eyes (mean follow-up 48.8±43.3 months). DMEK achieved significantly better BCVA at all timepoints (P<0.001). At 10 years after surgery, BCVA was 0.17±0.26 and 0.05±0.08 LogMAR, respectively for DSAEK and DMEK (P=0.006), whereas there was no significant difference in ECD (967±399 vs 941±429 cells/mm2, respectively; P=0.70). A biexponential regression model predicted ECD to reach 500 cells/mm2 at 19.7 and 21.5 years, respectively. At 10 years, ECL was comparable (62.6±15.5% vs 63.1±16.2%; P=0.88). Rebubbling rate was significantly higher for DMEK (1.6% vs 17.3%; P<0.001). Ten-year graft survival rates were 97.9% vs 99.2% (P=0.26) and rejection-free survival rates were 96.3% vs 97.7%, respectively (P=0.67).
Conclusions
According to our findings, DMEK provided superior visual outcomes compared with DSAEK throughout 10 years of follow-up, despite a significantly higher rebubbling rate. ECL was comparable between groups, and both techniques demonstrated excellent long-term graft survival and rejection-free rates.