Ultrathin Descemet stripping automated endothelial keratoplasty versus Descemet membrane endothelial keratoplasty: a fellow-eye comparison

In the past decade endothelial keratoplasty has become the gold standard for the treatment of endothelial dysfunctions, such as Fuchs endothelial dystrophy or pseudophakic bullous keratopathy. More recently a new procedure that allows us to selectively transplant only the Descemet membrane and the endothelium, Descemet Membrane Endothelial Keratoplasty (DMEK), has been developed; this technique is a refinement of Descemet stripping automated endothelial keratoplasty (DSAEK), where a relatively thick graft composed of endothelium, Descemet membrane and a variable portion of posterior stroma is transplanted. Due to its quicker postoperative recovery and similar or better visual outcome and lower rejection rates, DMEK has rapidly gained popularity, even though its widespread adoption is still limited by the difficult and less predictable surgical technique that prevents its use in complicated cases, and by its higher rates of postoperative rebubbling. Nevertheless, recently-published studies suggest that DSAEK grafts thinner than 130 µm (ultrathin, UT-DSAEK) may lead to postoperative visual outcomes which are better than conventional DSAEK and comparable to DMEK. In this context, the purpose of the study was to retrospectively compare the visual outcome and patients’ satisfaction after ultrathin Descemet stripping automated endothelial keratoplasty (UT-DSAEK) and Descemet membrane endothelial keratoplasty (DMEK) performed on the fellow eyes of the same patients.