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Klin Monbl Augenheilkd
DOI: 10.1055/a-2558-2583
Klinische Studie

Fellow Eye Comparison of Tomographic Parameters and Higher-Order Aberrations in Ultrathin Descemet Stripping Automated Endothelial Keratoplasty and Descemet Membrane Endothelial Keratoplasty

Vergleich von tomografischen Parametern und Aberrationen höherer Ordnung bei „Ultrathin Descemet Stripping Automated Endothelial Keratoplasty“ und „Descemet Membrane Endothelial Keratoplasty“
Tim Berger 
1   Department of Ophthalmology, Saarland University Medical Center, Homburg/Saar, Germany
,
Berthold Seitz 
1   Department of Ophthalmology, Saarland University Medical Center, Homburg/Saar, Germany
,
Shady Suffo 
1   Department of Ophthalmology, Saarland University Medical Center, Homburg/Saar, Germany
,
Ranko Gvozdenovic
2   Department of Ophthalmology, Clinic for Eye Diseases, University Clinical Centre of Serbia, Belgrade, Serbia
,
Yaser Abu Dail 
1   Department of Ophthalmology, Saarland University Medical Center, Homburg/Saar, Germany
,
Loay Daas
1   Department of Ophthalmology, Saarland University Medical Center, Homburg/Saar, Germany
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Abstract

Purpose To assess the functional outcomes of ultrathin Descemet stripping automated endothelial keratoplasty (UT-DSAEK) and Descemet membrane endothelial keratoplasty (DMEK) for Fuchs endothelial corneal dystrophy in fellow eyes.

Methods Retrospective study of 28 eyes (14 patients) undergoing UT-DSAEK in one eye and DMEK in the fellow eye with a follow-up of at least one year. Main outcomes were best-corrected visual acuity (BCVA), central corneal thickness (CCT), endothelial cell density (ECD), and anterior and posterior tomographic parameters, including corneal higher-order aberrations (HOAs).

Results The UT-DSAEK and DMEK groups showed no differences in donor characteristics or preoperative corneal tomographic parameters. BCVA improved in both groups, but visual recovery was faster in the DMEK group. CCT and ECD decreased in the UT-DSAEK and DMEK groups, but without differences between the groups. Posterior mean keratometry and posterior Q-value increased in the UT-DSAEK and DMEK groups with higher values of both parameters in the UT-DSAEK group. As regards corneal aberrations, higher root mean-square values for HOAs of the posterior cornea and higher values of posterior Trefoil were evident in the UT-DSAEK group than in the DMEK group.

Conclusion Visual quality after endothelial keratoplasty might depend not on visual acuity alone, but also on corneal aberrations and asphericity of the anterior and posterior corneal surface. The results support the benefits of DMEK over UT-DSAEK, suggesting the need for long-term studies with a larger number of patients.

Zusammenfassung

Hintergrund Untersuchung der funktionellen Ergebnisse der „Ultrathin Descemet Stripping Automated Endothelial Keratoplasty“ (UT-DSAEK) und „Descemet Membrane Endothelial Keratoplasty“ (DMEK) bei Fuchsʼscher endothelialer Hornhautdystrophie in Partneraugen.

Methoden Retrospektive Studie von 28 Augen (14 Patienten), die an einem Auge mit UT-DSAEK und am anderen Auge mit DMEK behandelt wurden, mit einem Follow-up von mindestens 1 Jahr. Die Hauptzielgrößen waren die bestkorrigierte Sehschärfe (BCVA), die zentrale Hornhautdicke (CCT), die Endothelzelldichte (ECD) sowie anteriore und posteriore tomografische Parameter einschl. der Hornhautaberrationen höherer Ordnung (HOAs).

Ergebnisse Die UT-DSAEK- und DMEK-Gruppe wiesen keine Unterschiede bei den Spendermerkmalen oder den präoperativen tomografischen Hornhautparametern auf. Der Visus verbesserte sich in beiden Gruppen, jedoch war die visuelle Erholung in der DMEK-Gruppe schneller. CCT und ECD verringerten sich in der UT-DSAEK- und DMEK-Gruppe, jedoch ohne Unterschiede zwischen den Gruppen. Die posteriore mittlere Keratometrie und der posteriore Q-Wert stiegen in der UT-DSAEK- und der DMEK-Gruppe an, wobei beide Parameter in der UT-DSAEK-Gruppe signifikant höhere Werte aufwiesen. Hinsichtlich der Hornhautaberrationen zeigten sich in der UT-DSAEK-Gruppe im Vergleich zur DMEK-Gruppe höhere Werte der RMS-HOAs für die posteriore Hornhaut und höhere Werte für das posteriore Trefoil.

Schlussfolgerung Die Visusqualität nach einer endothelialen Keratoplastik hängt möglicherweise nicht nur von der Sehschärfe allein ab, sondern auch von den Hornhautaberrationen und der Asphärizität der Vorder- und Rückfläche. Die Ergebnisse sprechen für die Vorteile der DMEK gegenüber der UT-DSAEK und weisen auf die Notwendigkeit von Langzeitstudien mit einer größeren Anzahl von Patienten hin.

Conclusion Box

Already known:

  • Descemet Membrane Endothelial Keratoplasty (DMEK) and Ultrathin Descemet Stripping Automated Endothelial Keratoplasty (UT-DSAEK) are established procedures for the treatment of endothelial corneal dystrophies.

  • It was not sufficiently understood how both procedures affect higher order aberrations (HOAs) and asphericity.

Newly described:

  • The results show that UT-DSAEK has a higher increase in posterior corneal aberrations (RMS HOAs and trefoil) than DMEK, indicating a lower optical quality with UT-DSAEK.

  • The posterior curvature and asphericity parameters (Kmean, Q-value) are higher in UT-DSAEK than in DMEK, which might be explained by the presence of additional stroma.

Keywords

UT-DSAEK - DMEK - keratoplasty - higher-order aberrations - astigmatism - corneal transplantation

Schlüsselwörter

UT-DSAEK - DMEK - Keratoplastik - Hornhauttransplantation - Aberrationen höherer Ordnung - Astigmatismus


Publication History

Received: 10 July 2024

Accepted: 11 March 2025

Article published online:
23 April 2025

© 2025. Thieme. All rights reserved.

Georg Thieme Verlag KG
Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany

 

  • References

  • 1 Hos D, Matthaei M, Bock F. et al. Immune reactions after modern lamellar (DALK, DSAEK, DMEK) versus conventional penetrating corneal transplantation. Prog Retin Eye Res 2019; 73: 100768
    CrossrefPubMedSearch in Google Scholar
  • 2 Fiorentzis M, Viestenz A, Seitz B. Immunological graft rejection with Khodadoust line after “Descemet stripping automated endothelial keratoplasty” (DSAEK). Ophthalmologe 2015; 112: 783-787
    CrossrefPubMedSearch in Google Scholar
  • 3 Price FW, Price MO. Descemetʼs Stripping With Endothelial Keratoplasty in 50 Eyes: A Refractive Neutral Corneal Transplant. J Refract Surg 2005; 21: 339-345
    CrossrefPubMedSearch in Google Scholar
  • 4 Price FW, Price MO. Descemetʼs stripping with endothelial keratoplasty in 200 eyes. Early challenges and techniques to enhance donor adherence. J Cataract Refract Surg 2006; 32: 411-418
    CrossrefPubMedSearch in Google Scholar
  • 5 Melles GR, Ong TS, Ververs B. et al. Descemet membrane endothelial keratoplasty (DMEK). Cornea 2006; 25: 987-990
    CrossrefPubMedSearch in Google Scholar
  • 6 Flockerzi E, Maier P, Böhringer D. et al. Trends in Corneal Transplantation from 2001 to 2016 in Germany: A Report of the DOG–Section Cornea and its Keratoplasty Registry. Am J Ophthalmol 2018; 188: 91-98
    CrossrefPubMedSearch in Google Scholar
  • 7 Flockerzi E, Turner C, Seitz B. et al. Descemetʼs membrane endothelial keratoplasty is the predominant keratoplasty procedure in Germany since 2016: a report of the DOG-section cornea and its keratoplasty registry. Br J Ophthalmol 2024; 108: 646-653
    CrossrefPubMedSearch in Google Scholar
  • 8 Romano V, Kazaili A, Pagano L. et al. Eye bank versus surgeon prepared DMEK tissues: Influence on adhesion and re-bubbling rate. Br J Ophthalmol 2022; 106: 177-183
    CrossrefPubMedSearch in Google Scholar
  • 9 Koo EH, Pineda R, Afshari N. et al. Learning Descemet Membrane Endothelial Keratoplasty: A Survey of U.S. Corneal Surgeons. Cornea 2020; 39: 590-593
    CrossrefPubMedSearch in Google Scholar
  • 10 Stuhlmacher ES, Suffo S, Munteanu C. et al. Assessing the Learning Curve for DMEK Using Post-Procedural Clinical Outcomes – Comparison of Four Different Surgeons during Two Different Periods. J Clin Med 2023; 12: 811
    CrossrefPubMedSearch in Google Scholar
  • 11 Shilova NF, Livny E, Anisimova NS. et al. Refractive outcomes following cataract combined with lamellar keratoplasty: femtosecond-DSEK versus microkeratome-DSAEK. Int Ophthalmol 2021; 41: 639-647
    CrossrefPubMedSearch in Google Scholar
  • 12 Arora R, Gupta P, Sahu J. et al. Analysis of Corneal Scheimpflug Densitometry and Ocular Wavefront Aberrations Post Descemet Stripping Automated Endothelial Keratoplasty. Eye Contact Lens 2022; 48: 242-249
    CrossrefPubMedSearch in Google Scholar
  • 13 Unterlauft JD, Elsässer K, Haigis W. et al. Corneal back surface radius after DSEK and DSAEK: A comparative single surgeon case control study. Int Ophthalmol 2014; 35: 533-540
    CrossrefPubMedSearch in Google Scholar
  • 14 Nahum Y, Leon P, Busin M. Postoperative graft thickness obtained with single-pass microkeratome-assisted ultrathin Descemet stripping automated endothelial keratoplasty. Cornea 2015; 34: 1362-1364
    CrossrefPubMedSearch in Google Scholar
  • 15 Langenbucher A, Szentmáry N, Spira C. et al. [Corneal power after Descemet stripping automated endothelial keratoplasty (DSAEK) – Modeling and concept for calculation of intraocular lenses]. Z Med Phys 2016; 26: 120-126
    CrossrefPubMedSearch in Google Scholar
  • 16 Schoenberg ED, Price FW, Miller J. et al. Refractive outcomes of Descemet membrane endothelial keratoplasty triple procedures (combined with cataract surgery). J Cataract Refract Surg 2015; 41: 1182-1189
    CrossrefPubMedSearch in Google Scholar
  • 17 Wykrota AA, Weinstein I, Hamon L. et al. Approval rates for corneal donation and the origin of donor tissue for transplantation at a university-based tertiary referral center with corneal subspecialization hosting a LIONS Eye Bank. BMC Ophthalmol 2022; 22: 17
    CrossrefPubMedSearch in Google Scholar
  • 18 Schmitz L, Safi T, Munteanu C. et al. Prevalence and severity of cornea guttata in the graft following Descemet Membrane Endothelial Keratoplasty (DMEK). Acta Ophthalmol 2022; 100: e1737-e1745
    CrossrefPubMedSearch in Google Scholar
  • 19 Safi T, Seitz B, Berg K. et al. Reproducibility of Non-Invasive Endothelial Cell Loss Assessment of the Pre-Stripped DMEK Roll After Preparation and Storage. Am J Ophthalmol 2021; 221: 17-26
    CrossrefPubMedSearch in Google Scholar
  • 20 Seitz B, Daas L, Bischoff-Jung M. et al. Anatomy-based DMEK Wetlab in Homburg/Saar: Novel aspects of donor preparation and host maneuvers to teach Descemet membrane endothelial keratoplasty. Clin Anat 2018; 31: 16-27
    CrossrefPubMedSearch in Google Scholar
  • 21 Seitz B, Daas L, Flockerzi E. et al. [Descemet membrane endothelial keratoplasty DMEK – Donor and recipient step by step]. Ophthalmologe 2020; 117: 811-828
    CrossrefPubMedSearch in Google Scholar
  • 22 Abdin A, Daas L, Pattmöller M. et al. Negative impact of dextran in organ culture media for pre-stripped tissue preservation on DMEK (Descemet membrane endothelial keratoplasty) outcome. Graefes Arch Clin Exp Ophthalmol 2018; 256: 2135-2142
    CrossrefPubMedSearch in Google Scholar
  • 23 Bachmann BO, Laaser K, Cursiefen C. et al. A Method to Confirm Correct Orientation of Descemet Membrane During Descemet Membrane Endothelial Keratoplasty. Am J Ophthalmol 2010; 149: 922-925.e2
    CrossrefPubMedSearch in Google Scholar
  • 24 Turnbull AMJ, Tsatsos M, Hossain PN. et al. Determinants of visual quality after endothelial keratoplasty. Surv Ophthalmol 2016; 61: 257-271
    CrossrefPubMedSearch in Google Scholar
  • 25 Dirisamer M, Parker J, Naveiras M. et al. Identifying causes for poor visual outcome after DSEK/DSAEK following secondary DMEK in the same eye. Acta Ophthalmol 2013; 91: 131-139
    CrossrefPubMedSearch in Google Scholar
  • 26 Machalińska A, Kuligowska A, Kaleta K. et al. Changes in Corneal Parameters after DMEK Surgery: A Swept-Source Imaging Analysis at 12-Month Follow-Up Time. J Ophthalmol 2021; 2021: 3055722
    CrossrefPubMedSearch in Google Scholar
  • 27 Pavlovic I, Shajari M, Herrmann E. et al. Meta-Analysis of postoperative outcome parameters comparing Descemet membrane endothelial keratoplasty versus Descemet stripping automated endothelial keratoplasty. Cornea 2017; 36: 1445-1451
    CrossrefPubMedSearch in Google Scholar
  • 28 Singh A, Zarei-Ghanavati M, Avadhanam V. et al. Systematic Review and Meta-Analysis of Clinical Outcomes of Descemet Membrane Endothelial Keratoplasty Versus Descemet Stripping Endothelial Keratoplasty/Descemet Stripping Automated Endothelial Keratoplasty. Cornea 2017; 36: 1437-1443
    CrossrefPubMedSearch in Google Scholar
  • 29 Zhu L, Zha Y, Cai J. et al. Descemet stripping automated endothelial keratoplasty versus Descemet membrane endothelial keratoplasty: a meta-analysis. Int Ophthalmol 2018; 38: 897-905
    CrossrefPubMedSearch in Google Scholar
  • 30 Stuart AJ, Romano V, Virgili G. et al. Descemetʼs membrane endothelial keratoplasty (DMEK) versus Descemetʼs stripping automated endothelial keratoplasty (DSAEK) for corneal endothelial failure. Cochrane Database Syst Rev 2018; (06) CD012097
    CrossrefPubMedSearch in Google Scholar
  • 31 Mencucci R, Favuzza E, Marziali E. et al. Ultrathin Descemet stripping automated endothelial keratoplasty versus Descemet membrane endothelial keratoplasty: a fellow-eye comparison. Eye Vis (Lond) 2020; 7: 1-9
    CrossrefPubMedSearch in Google Scholar
  • 32 Weisenthal RW, Yin HY, Jarstad AR. et al. Long-term Outcomes in Fellow Eyes Comparing DSAEK and DMEK for Treatment of Fuchs Corneal Dystrophy. Am J Ophthalmol 2022; 233: 216-226
    CrossrefPubMedSearch in Google Scholar
  • 33 Machalińska A, Kuligowska A, Kowalska B. et al. Comparative Analysis of Corneal Parameters in Swept-Source Imaging between DMEK and UT-DSAEK Eyes. J Clin Med 2021; 10: 5119
    CrossrefPubMedSearch in Google Scholar
  • 34 Droutsas K, Lazaridis A, Giallouros E. et al. Scheimpflug Densitometry After DMEK Versus DSAEK-Two-Year Outcomes. Cornea 2018; 37: 455-461
    CrossrefPubMedSearch in Google Scholar
  • 35 Chamberlain W, Lin CC, Austin A. et al. Descemet Endothelial Thickness Comparison Trial: A Randomized Trial Comparing Ultrathin Descemet Stripping Automated Endothelial Keratoplasty with Descemet Membrane Endothelial Keratoplasty. Ophthalmology 2019; 126: 19-26
    CrossrefPubMedSearch in Google Scholar
  • 36 Goldich Y, Showail M, Avni-Zauberman N. et al. Contralateral eye comparison of Descemet membrane endothelial keratoplasty and Descemet stripping automated endothelial keratoplasty. Am J Ophthalmol 2015; 159: 155-159.e1
    CrossrefPubMedSearch in Google Scholar
  • 37 Guerra FP, Anshu A, Price MO. et al. Endothelial keratoplasty: Fellow eyes comparison of Descemet stripping automated endothelial keratoplasty and Descemet membrane endothelial keratoplasty. Cornea 2011; 30: 1382-1386
    CrossrefPubMedSearch in Google Scholar
  • 38 Bhandari V, Reddy JK, Relekar K. et al. Descemetʼs Stripping Automated Endothelial Keratoplasty versus Descemetʼs Membrane Endothelial Keratoplasty in the Fellow Eye for Fuchs Endothelial Dystrophy: A Retrospective Study. Biomed Res Int 2015; 2015: 750567
    CrossrefPubMedSearch in Google Scholar
  • 39 Cheung AY, Chachare DY, Eslani M. et al. Tomographic changes in eyes with hyperopic shift after triple Descemet membrane endothelial keratoplasty. J Cataract Refract Surg 2018; 44: 738-744
    CrossrefPubMedSearch in Google Scholar
  • 40 Ademmer V, Agha B, Shajari M. et al. Impact of DMEK on visual quality in patients with Fuchsʼ endothelial dystrophy. Graefes Arch Clin Exp Ophthalmol 2022; 260: 521-528
    CrossrefPubMedSearch in Google Scholar
  • 41 Agha B, Ahmad N, Dawson DG. et al. Refractive outcome and tomographic changes after Descemet membrane endothelial keratoplasty in pseudophakic eyes with Fuchsʼ endothelial dystrophy. Int Ophthalmol 2021; 41: 2897-2904
    CrossrefPubMedSearch in Google Scholar
  • 42 Meek KM, Leonard DW, Connon CJ. et al. Transparency, swelling and scarring in the corneal stroma. Eye (Lond) 2003; 17: 927-936
    CrossrefPubMedSearch in Google Scholar
  • 43 Droutsas K, Lazaridis A, Papaconstantinou D. et al. Visual outcomes after Descemet membrane endothelial keratoplasty versus Descemet stripping automated endothelial keratoplasty-comparison of specific matched pairs. Cornea 2016; 35: 765-771
    CrossrefPubMedSearch in Google Scholar
  • 44 Muijzer MB, van Luijk CM, van den Bogaerdt AJ. et al. Prospective evaluation of clinical outcomes between pre-cut corneal grafts prepared using a manual or automated technique: with one-year follow-up. Acta Ophthalmol 2019; 97: 714-720
    CrossrefPubMedSearch in Google Scholar
  • 45 Alnawaiseh M, Zumhagen L, Rosentreter A. et al. Changes in Anterior, Posterior, and Total Corneal Astigmatism after Descemet Membrane Endothelial Keratoplasty. J Ophthalmol 2017; 2017: 4068963
    CrossrefPubMedSearch in Google Scholar
  • 46 Trindade BLC, Garcia JC, Nogueira LR. Toric IOL in combined DMEK and cataract surgery. Clin Ophthalmol 2021; 15: 1511-1516
    CrossrefPubMedSearch in Google Scholar
  • 47 Yokogawa H, Sanchez PJ, Mayko ZM. et al. Astigmatism Correction with Toric Intraocular Lenses in Descemet Membrane Endothelial Keratoplasty Triple Procedures. Cornea 2017; 36: 269-274
    CrossrefPubMedSearch in Google Scholar
  • 48 Waldrop WH, Gillings MJ, Robertson DM. et al. Lower corneal haze and aberrations in Descemet membrane endothelial keratoplasty versus Descemet stripping automated endothelial keratoplasty in fellow eyes for Fuchs endothelial corneal dystrophy. Cornea 2020; 39: 1227-1234
    CrossrefPubMedSearch in Google Scholar
  • 49 Duggan MJ, Rose-Nussbaumer J, Lin CC. et al. Corneal Higher-Order Aberrations in Descemet Membrane Endothelial Keratoplasty versus Ultrathin DSAEK in the Descemet Endothelial Thickness Comparison Trial: A Randomized Clinical Trial. Ophthalmology 2019; 126: 946-957
    CrossrefPubMedSearch in Google Scholar
  • 50 Tourabaly M, Chetrit Y, Provost J. et al. Influence of graft thickness and regularity on vision recovery after endothelial keratoplasty. Br J Ophthalmol 2020; 104: 1317-1323
    CrossrefPubMedSearch in Google Scholar
  • 51 Artal P, Guirao A, Berrio E. et al. Compensation of corneal aberrations by the internal optics in the human eye. J Vis 2001; 1: 1-8
    CrossrefPubMedSearch in Google Scholar