Fellow Eye Comparison of DMEK and DSAEK: Corneal Perspective
Narrative Responses:
Purpose
To compare posterior corneal curvature in the fellow eye of the same patients after Descemet’s membrane endothelial keratoplasty (DMEK) and Descemet’s stripping automated endothelial keratoplasty (DSAEK).
Methods
This retrospective case series comparative study included consecutive patients who underwent DSAEK in one eye and DMEK in the fellow eye. Each eye underwent corneal evaluation with Pentacam HR (Oculus,Wetzlar, Germany). Corneal curvature, corneal thickness and visual acuity were assessed. Twenty eyes of ten patients (5 females and 5 males) aged 72.5 ± 13.5 (mean±SD) years (range 42-87 years) were included. All patients were previously diagnosed with Fuch’s endothelial dystrophy. In 4 eyes undergoing DMEK and in 3 eyes undergoing DSAEK a cataract was present and was removed at the time of surgery.
Results
Mean follow-up time (months) was 7.1±2.6 for DMEK and 30.6±14.0 for DSAEK. Final best corrected visual acuity (logMAR) was 0.23±0.1 and 0.32±0.2 in DMEK and DSAEK eyes, respectively (P=0.2). No significant differences were observed between front flat K’s (D) (43.01±1.6vs43.5±0.9,P=0.27) and front steep K’s (D) (44.17±1.5vs44.52±0.7,P=0.39) in DMEK vs DSAEK eyes, accordingly. Posterior curvature was statistically significantly flatter in DMEK than in DSAEK eyes, namely, back flat K’s (D) (-6.30±0.2vs-6.84±0.6,P=0.012), back steep K’s (D) (-6.64±0.1vs-7.2±0.3,P=0.03), and back Km (D) (-6.45±0.1vs-6.99±0.4,P=0.005), accordingly. Corneas in DMEK eyes were significantly thinner than in DSAEK eyes (541.0±61vs627.9±70mic,P=0.007)
Conclusion
Eyes that underwent DSAEK surgery have thicker corneas and steeper posterior corneal curvature than fellow eyes that underwent DMEK. This difference may explain hyperopic shift commonly observed after DSAEK and should be considered when choosing intraocular lens for cataract surgery.