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Comparison of Visual Acuity Outcomes Between Nanothin Descemet Stripping Automated Endothelial Keratoplasty and Descemet Membrane Endothelial Keratoplasty

Kurji, Khaliq H. MD, MSc, FRCSC*,†; Cheung, Albert Y. MD*,†,‡; Eslani, Medi MD*; Rolfes, Erin J. OD*; Chachare, Deepali Y. RPh*; Auteri, Nicholas J. BSc*; Nordlund, Michael L. MD, PhD*,†; Holland, Edward J. MD*,†

doi: 10.1097/ICO.0000000000001697
Clinical Science

Purpose: To compare the visual outcomes and complications between nanothin Descemet stripping automated endothelial keratoplasty (NT-DSAEK) and Descemet membrane endothelial keratoplasty (DMEK).

Methods: A prospective comparative case series of 28 consecutive cases of NT-DSAEK (less than or equal to 50 μm) and DMEK was undertaken. Inclusion criteria were a diagnosis of Fuchs dystrophy, presence of pseudophakia, or planned combined cataract surgery/endothelial keratoplasty, with a minimum of 6-month follow-up. Exclusion criteria were any concurrent ocular comorbidities. Primary outcomes measures were best spectacle-corrected visual acuity (BSCVA) and complications.

Results: Mean thickness of NT-DSAEK grafts was 41.0 ± 7.5 μm (range 26–50 μm). At 1 month postoperatively, the DMEK group had significantly better mean BSCVA of 0.18 ± 0.20 logarithm of the minimum angle of resolution (logMAR) (20/33) compared with 0.28 ± 0.16 logMAR (20/40) for NT-NSAEK (P = 0.049). At 3, 6, and 12 months postoperatively, mean BSCVA was comparable between both groups [3 months: NT-DSAEK 0.17 ± 0.12 logMAR (20/30) versus DMEK 0.13 ± 0.17 (20/27), P = 0.31; 6 months: NT-DSAEK 0.11 ± 0.10 logMAR (20/26) versus DMEK 0.09 ± 0.10 (20/25), P = 0.63; 12 months: NT-DSAEK 0.07 ± 0.09 logMAR (20/24) versus DMEK 0.07 ± 0.11 logMAR (20/24), P = 0.95]. Other than 1 NT-DSAEK graft that was successfully rebubbled, no other complications were encountered in either group.

Conclusions: Compared with DMEK, NT-DSAEK provides comparable visual outcomes and complications rates.

*Cincinnati Eye Institute, Cincinnati, OH;

Department of Ophthalmology, University of Cincinnati, Cincinnati, OH; and

Virginia Eye Consultants, Norfolk, VA.

Correspondence: Edward J. Holland, MD, Cincinnati Eye Institute, 580 South Loop Rd, Suite 200, Edgewood, KY 41017 (e-mail:

E. J. Holland has consulted for Alcon Laboratories, Allergan, Bausch & Lomb, Kala Pharmaceuticals, Mati Pharmaceuticals, Omeros, PRN, RPS, Senju Pharmaceuticals, Shire, TearLab, and TearScience. M. L. Nordlund has consulted for Alcon Laboratories, Shire. A. Y. Cheung has a grant from Eye Bank Association of America. The remaining authors have no funding or conflicts of interest to disclose.

Received February 27, 2018

Received in revised form May 27, 2018

Accepted May 30, 2018

Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.