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  • Visual function after ultrathin Descemet’s stripping automated endothelial keratoplasty or Descemet’s membrane endothelial keratoplasty combined with cataract surgery: a randomised controlled clinical trial

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Clinical science
Visual function after ultrathin Descemet’s stripping automated endothelial keratoplasty or Descemet’s membrane endothelial keratoplasty combined with cataract surgery: a randomised controlled clinical trial
  1. Morten Brok Molbech Madsen,
  2. Anders Ivarsen,
  3. Jesper Hjortdal
  1. Department of Ophthalmology, Aarhus University Hospital, Aarhus N, Denmark
  1. Correspondence to Dr Morten Brok Molbech Madsen, Aarhus University Hospital Department of Ophthalmology, Aarhus N, DK-8200, Denmark; mmm{at}clin.au.dk

Abstract

Aims To compare best-corrected visual acuity (BCVA), contrast sensitivity and endothelial cell density (ECD) after ultrathin Descemet’s stripping automated endothelial keratoplasty (UT-DSAEK) and Descemet’s membrane endothelial keratoplasty (DMEK).

Methods A randomised, single-blinded, single-centre design was used. 72 patients with Fuchs’ endothelial dystrophy and cataract were randomised to UT-DSAEK or DMEK combined with phacoemulsification and lens implantation. 27 patients with cataract were included in a control group and treated with phacoemulsification and lens implantation. The primary outcome was BCVA at 12 months.

Results Compared with UT-DSAEK, DMEK resulted in better BCVA with mean differences of 6.1 early treatment diabetic retinopathy study (ETDRS) (p=0.001) after 3 months, 7.4 ETDRS (p<0.001) after 6 months and 5.7 ETDRS (p<0.001) after 12 months. The control group obtained significantly better BCVA with a mean difference of 5.2 ETDRS (p<0.001) compared with DMEK 12 months postoperatively. Compared with UT-DSAEK, contrast sensitivity was significantly better 3 months after DMEK with a mean difference of 0.10 LogCS (p=0.03). However, our study found no effect after 12 months (p=0.08). ECD was significantly lower after UT-DSAEK compared with DMEK with mean differences of 332 cells/mm2 (p<0.01) after 3 months, 296 cells/mm2 (p<0.01) after 6 months and 227 cells/mm2 (p=0.03) after 12 months.

Conclusions Compared with UT-DSAEK, DMEK resulted in better BCVA 3, 6 and 12 months postoperatively. Twelve months postoperatively, DMEK had a higher ECD than UT-DSAEK; however, no difference in contrast sensitivity was found.

Trial registration number NCT04417959

  • Vision
  • Dystrophy
  • Cornea
  • Clinical Trial

Data availability statement

Data are available upon reasonable request.

http://dx.doi.org/10.1136/bjo-2023-323304

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    Data availability statement

    Data are available upon reasonable request.

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    Footnotes

    • Contributors MBMM is guarantor

    • Funding The study received financial support from Synoptik-Fonden, Fight for Sight Denmark, Helene og Viggo Bruuns Fond, Kirsten Friis-Nielsens Forskningsfond and Jochum Jensen og hustru Mette Marie Jensen, f. Poulsens Mindelegat. Funding organisations had no role in the design or conduct of this research. The funding sources had no role in the conduct of this trial or relation to the authors. No grant number was affiliated.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.