‘Nano-thin’ grafts have recently begun to be used for DSAEK. Long-term data are needed to see how the outcomes of this technique compare with DMEK.
Reviewed by Clara C. Chan, MD
Corresponding with the evolution in techniques for endothelial keratoplasty (EK), there has been a debate over which procedure corneal surgeons should perform. Going forward, the discussion will be about the battle between Descemet’s membrane endothelial keratoplasty (DMEK) and nano-thin Descemet’s stripping automated endothelial keratoplasty (NT-DSAEK), said Clara C. Chan, MD.
“Surgeons performing DSAEK first migrated to ultrathin (UT) DSAEK, and now we will see migration to NT-DSAEK,” Dr. Chan said. “The use of thinner graft tissue has benefits of a lower rejection rate, more predictable tissue handling, fewer detachments, and lower rebubbling rates.”
“We know that, when compared with DSAEK using thicker grafts, DMEK seems to be associated with lower higher-order aberrations (HOAs) and faster visual recovery,” she said. “Studies are needed to compare long-term outcomes of DMEK with UT- and NT-DSAEK.”
Dr. Chan reviewed published literature comparing outcomes with different EK techniques. She cited the 2008 American Academy of Ophthalmology (AAO) Ophthalmic Technology Assessment report on Descemet’s stripping endothelial keratoplasty (DSEK), noting that the first outcomes study on DSEK appeared in the peer-reviewed literature in 2005.
In 2006, the first report of DMEK appeared in the peer-reviewed literature. Thin DSAEK, using a graft with a thickness <100μm was described in 2011, and the first randomly selected controlled trial comparing DMEK and UT-DSAEK (average central graft thickness 73 microns) was reported this year. Patients included in the study had Fuch’s endothelial dystrophy or pseudophakic bullous keratopathy and were followed for 12 months after surgery.
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Clara C. Chan, MD
E: [email protected]
This article was adapted from Dr. Chan’s presentation during the 2019 meeting of the American Society of Cataract and Refractive Surgery. Dr. Chan has no disclosures.