To compare the outcome between posterior lamellar corneal transplant procedures for Fuchs´ endothelial corneal dystrophy, taking preoperative patient characteristics in consideration. Surgical methods compared were: Descemet membrane endothelial keratoplasty (DMEK), Descemet stripping automated endothelial keratoplasty (DSAEK) and DSAEK with concomitant cataract surgery (phaco/DSAEK).
Register-based study with propensity score matching.
1677 cases from all Swedish corneal transplantation units performed 2012-19.
All endothelial keratoplasties performed 2012-19 with a completed two-year follow-up-data reported to The Swedish Corneal Transplant Register were included, totally 1677 cases. Three comparable groups (DMEK, DSAEK, phaco/DSAEK) with 216 cases in each group were generated with propensity score matching based on preoperative visual acuity, age, sex, year of surgery and preoperative risk factors such as inflammation, vascularisation and glaucoma.
Best corrected visual acuity (BCVA) at the two-year follow-up, frequency of graft dislocation, graft rejection episodes, and graft failure within two years including primary graft failure.
The preoperative corneal status was more severely affected in the DSAEK group before matching. In the matched groups, the median BCVA two years after surgery was 0.1 logMAR in both the DMEK and the phaco/DSAEK groups and 0.15 logMAR in the DSAEK group (P=.001). The frequency of graft dislocation was higher among the phaco/DSAEK-patients, but the frequency of graft failure and primary graft failure was higher in the DMEK-group.
The visual acuity improved in the majority of cases (90%) with all three surgical methods. However, DMEK and phaco/DSAEK reached higher levels of visual acuity two years after the surgery and phaco/DSAEK was superior considering the graft survival rate. All three surgical procedures showed both strengths and weaknesses suggesting that the choice of surgical method should be individualized and take into consideration not only cornea but patient´s complete medical status as well as the whole course of postoperative medical care.

Copyright © 2023. Published by Elsevier Inc.