Corneal Densitometry and Visual Outcome Comparisons of DSAEK and DMEK Eyes Xiaolin Zhang MD Robert L. Schultze MD Robert A. Eden MD Rahul Raghu
Dec 21, 2015
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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