Abstract
PurposeBased on current evidence, the efficiency and safety of Descemet’s membrane endothelial keratoplasty (DMEK) was compared with that of Descemet’s stripping endothelial keratoplasty (DSEK).MethodsPubmed, Embase, Web of Science, the Cochrane Database and conference abstracts were comprehensively searched for studies that compared the efficacy and safety of DMEK and DSEK. The efficacy outcome was the postoperative best-corrected visual acuity (BCVA). The safety outcomes included the postoperative endothelial cell density (ECD) and complications such as graft detachment, graft rejection, graft failure, postoperative elevated intraocular pressure (IOP), tissue loss, etc. The outcomes were pooled using random-effects models with Stata 13.0 software. Heterogeneity was qualified with Q statistic and I2/H2 statistic. Publication bias was assessed using funnel plot, Begg rank correlation test, and Egger or Horbard linear regression.Results19 articles were eligible, and 1124 eyes and 1254 eyes were included in the DMEK and DSEK groups, respectively. The overall pooled estimates showed a significantly better postoperative BCVA, a comparable ECD and an increased graft detachment rate in the DMEK group compared with the DSEK group (BCVA: mean difference (MD) = -0.15, 95% CI = -0.19 to -0.11, P<0.001; ECD: MD = 14.88, 95% CI = -181.50 to 211.27, P = 0.882; graft detachment rate: OR = 4.56, 95% CI = 2.43 to 8.58, P<0.001). Except for the postoperative ECD, which was changed to be higher in the DSEK group than the DMEK group, the learning curve did not have a marked effect on the comparison outcome of the BCVA and graft detachment rate based on the estimates pooled from studies that collected data during the DMEK learning phase (ECD (learning curve): MD = -361.24, 95% CI = -649.42 to -73.07, P = 0.014).ConclusionAlthough DMEK is a more technically difficult and challenging procedure, it may represent a safe and more efficient alternative to DSEK for the treatment of corneal endothelial diseases, even during its learning curve.
Highlights
In 2004, corneal transplantation took a great advance by introducing a new technique termed “Descemet’s stripping endothelial keratoplasty” (DSEK)[1,2,3]
The overall pooled estimates showed a significantly better postoperative best corrected visual acuity (BCVA), a comparable endothelial cell density (ECD) and an increased graft detachment rate in the Descemet’s membrane endothelial keratoplasty” (DMEK) group compared with the DSEK group (BCVA: mean difference (MD) = -0.15, 95% confidence intervals (CIs) = -0.19 to -0.11, P
DSEK has been rapidly adopted by surgeons worldwide, and it has gradually become the standard surgical treatment for corneal endothelial problems, such as Fuchs corneal dystrophy, pseudophakic bullous keratopathy (PBK) and iridocorneal endothelial (ICE) syndrome, because of its short learning curve, good clinical outcomes, easier donor preparation and manipulation, and reproducible results[5, 6]
Summary
In 2004, corneal transplantation took a great advance by introducing a new technique termed “Descemet’s stripping endothelial keratoplasty” (DSEK)[1,2,3]. In this new keratoplasty procedure, the patient’s diseased endothelium and Descemet’s membrane are replaced with posterior corneal stroma, Descemet’s membrane and endothelium from the donor cornea[1, 2, 4]. To fully retain the anatomy of the recipient’s cornea, endothelial keratoplasty (EK) was used with the introduction by Melles in 2006 of “Descemet’s membrane endothelial keratoplasty” (DMEK), which transplants a lamella of Descemet’s membrane and endothelium without an adherent donor corneal stroma[9]. The number of DMEK cases performed each year in the United States has doubled every year; DSEK is still the dominant surgical treatment of choice for endothelial diseases[10]
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
