DSAEK results in better visual acuity values compared with DLEK and DSEK

Evaluation of the visual, topographic, and astigmatic results of small-incision deep lamellar endothelial keratoplasty (DLEK), Descemet's stripping endothelial keratoplasty (DSEK), and Descemet's stripping automated endothelial keratoplasty (DSAEK) indicated that 6 months postoperatively there are visual acuity differences, with DSAEK providing high visual acuity levels, reported Neda Shamie, MD, Devers Eye Institute, Portland, OR.

"With the rapid evolution in the procedures, the burden is on us to show that this evolution is in fact a move toward improvement," Dr. Shamie said. She and her colleagues conducted a prospective comparative case series of DLEK (n = 205 cases), DSAEK (n = 80 cases), and DSEK (n = 26 cases) performed by three surgeons.

Dr. Shamie reported that the mean astigmatic and mean keratometric values were essentially the same in the three groups, with no changes from the preoperative values.

"The visual acuity values at 6 months postoperatively differed among the groups," she reported. The mean DLEK visual acuity was 20/43 (range, 20/20 to 20/100) in 158 cases; the mean DSEK visual acuity was 20/50 (range, 20/20 to 20/63) in 20 cases; and the mean DSAEK visual acuity was 20/30 (range, 20/20 to 20/50) in 63 cases.

There was no statistical difference between the visual acuity levels of DLEK and DSEK after 6 months. There was a significant difference between DLEK and DSAEK (p p

Ninety-four percent of the DSAEK eyes reached a visual acuity of 20/40 at 6 months compared with only 59% of the DLEK eyes and 50% of the DSEK eyes. The respective percents for 20/20 or better vision at 6 months were 13%, 6%, and 1%.

"What is the reason for the differences in visual acuity? Patient variables, preexisting changes in residual stroma, and the power of the study are important qualities to think about. However, the interface quality is likely the main variable," Dr. Shamie concluded.