Corneal Densitometry and Visual Outcome Comparisons of DSAEK and DMEK Eyes Xiaolin Zhang MD Robert L. Schultze MD Robert A. Eden MD Rahul Raghu.

Corneal Densitometry and Visual Outcome Comparisons of

DSAEK and DMEK Eyes

Xiaolin Zhang MDRobert L. Schultze MD

Robert A. Eden MDRahul Raghu

Financial Disclosure• Robert L. Schultze is a member of the speaker’s bureau

and receives research funding from Bausch + Lomb, Inc.• All other authors have no financial interests to disclose

Introduction• DSAEK • DMEK

• Easier technique• Applicable to more diseased

eyes (ie-post vitrectomy, ACIOL, post glaucoma surgeries)

• Less dislocation rates

• Faster visual recovery• Better visual outcomes• Less endothelial rejection

Hypothesis• Faster and better visual outcomes in DMEK vs. DSAEK

could be related to differences in corneal light scatter, which is measured as corneal optical densitometry (CD).

Purpose• To compare pre-op and 6-month post-op corneal

densitometry (CD) and visual outcomes in patients undergoing either Descemet’s stripping automated endothelial keratoplasty (DSAEK) or Descemet membrane endothelial keratoplasty (DMEK) surgery

Methods• Retrospective review of 46 DMEK and 32 DSAEK surgeries

for treatment of Fuchs’ dystrophy.

• Eyes with non-corneal vision limiting pathologies were excluded.

• DMEK and DSAEK eyes were matched to similar pre-op visual acuity and pachymetry.

• Pre-op and 6 month post-op corrected distance visual acuity (CDVA), CD, and pachymetry were collected. CD was measured using the Oculus Pentacam® tomography and reported in standardized greyscale units (GSU).

• Data was analyzed using t-test and Wilcoxon rank-sum and signed-rank tests.

LogMAR Visual Acuity

Pre-op LogMAR VA Post-op LogMAR VA

P=0.002

DSAEK

DMEK

Pachymetry

Pre-op Pachymetry Post-op Pachymetry

P<0.001

DSAEK

DMEK

µm

Corneal Densitometry

Pre-op CD Post-op CD

P<0.001

P<0.001

DSAEK

DMEK

GS

U

Change from pre-op to 6 months post-op

DSAEK (n=32) DMEK P-value between groups

Mean Change in LogMAR VA

0.10 (p=0.0039) 0.28 (p<0.001)(n=46)

<0.001

Mean Change in Pachymetry (µm)

7.19 (p=0.627) 130.16 (p=<0.001)(n=45)

<0.001

Mean Change in Corneal Densitometry (GSU)

9.09 (p<0.001) 3.08 (p<0.001)(n=28)

<0.001

Conclusion• DMEK appears to provide better visual outcomes

compared to DSAEK surgery. • Corneal densitometry measurements improved as a

result of both surgeries.• Possible selection bias due to worse pre-op corneal

densitometry readings in DSAEK vs. DMEK eyes which could be why there was a greater reduction in mean CD in DSAEK vs. DMEK eyes.

• Further studies with larger sample size are needed to confirm these findings.

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