Ultrathin Descemet's Stripping Automated Endothelial Keratoplasty Using the Double-pass Technique with the Microkeratome versus Standard Descemet's Stripping Automated Endothelial Keratoplasty

Abstract

Purpose The aim of the present study was to compare the results of Descemet's stripping automated endothelial keratoplasty (DSAEK) and ultrathin Descemet's stripping automated endothelial keratoplasty (UT-DSAEK) that were performed with a standardized technique at a single institution. Design The present study was designed as a single-center, prospective, randomized nonblinded study. Participants and methods Sixty-one and 51 eyes underwent DSAEK and UT-DSAEK, respectively, for any endothelial disease at the ‘Villa Igea’ Center. Patients with pre-existing ocular comorbidity that impacted visual potential such as macular degeneration, amblyopia, advanced glaucoma, and other optic neuropathies were excluded from the study. Best-corrected visual acuity (BCVA) (in Snellen acuity chart) was obtained and specular microscopy of donor corneal tissue was performed before surgery. Postoperative complications, BCVA, and the percent of endothelial cell loss (ECL) recorded at 1, 3, 6 months, and 1 year were compared. Main outcome measures Visual acuity improvement, ECL, intraoperative postoperative complications, iatrogenic primary graft failure, and rebubbling were the main outcome measures in this study. Results Mean ± SD BCVA improved from 0.17 ± 0.13 and 0.19 ± 0.13 before surgery to 0.75 ± 0.18 and 0.88 ± 0.19 at 1 year after DSAEK and UT-DSAEK, respectively (P = 0.001). ECL was 33.88 ± 17.74% after DSAEK and 36.37 ± 13.10% after UT-DSAEK (P = 0.4080). There were no iatrogenic primary graft failures after the two procedures but there were two late endothelial failures after DSAEK. Rebubbling was performed for four of 51 eyes after UT-DSAEK and for none after DSAEK (P = 0.04). Conclusion Compared with DSAEK, UT-DSAEK provided better visual recovery and comparable ECL. The UT-DSAEK group had a higher percentage of rebubbling procedures but less rejection and failure rate.