Efficacy of Thin and Ultrathin Descemet Stripping Automated Endothelial Keratoplasty and Influence of Graft Thickness on Postoperative Outcomes: Systematic Review and Meta-analysis

circle PURPOSE: To conduct a systematic review and meta-analysis on the efficacy of thin and ultrathin Descemet stripping automated endothelial keratoplasty (T-DSAEK and UT-DSAEK, with graft thickness <130 and <100 mu m, respectively), depending on graft thickness. circle DESIGN: Systematic review and meta-analysis. circle METHOD: PubMed, Cochrane Library, Embase, Clini-calTrials. gov, and ScienceDirect databases were searched until October 1, 2021. We computed random-effect meta-analysis on postoperative outcomes of T/UT-DSAEK, stratified by graft thickness ( <80 mu m, 80-100 mu m, and 100-130 mu m). The main postoperative outcome was vi-sual acuity (logarithm of the minimum angle of resolution [logMAR]). Secondary outcomes were pachymetry (mu m), endothelial cell count (cell/mm(2)), spherical equiva-lent (diopter [D]), rebubbling rate (%), and rejection rate (%). Meta-regressions compared postoperative outcomes depending on graft thickness and search for putative confusion factors. circle RESULTS: We included 47 articles for a total of 2141 eyes of 2040 patients. T/UT-DSAEK globally improved visual acuity (effect size = -0.38 logMAR [95% confidence interval {CI} -0.46 to -0.30 logMAR]), with-out difference depending on graft thickness. Overall, pachymetry improved ( -60.6 mu m [95% CI -101 to -19.7 mu m]), endothelial cell count decreased (-1039 cells/mm2 [95% CI -1209 to -868 cells/mm(2)), spherical equivalent resulted in a hyperopic shift (0.74 D [95% CI -0.50 to 1.97 D), the graft rejection rate was 0.2% (95% CI -0.1% to 0.4%), and the rebubbling rate was 8.7% (95% CI 6.8%-10.5%). Grafts >100 mu m induced a hyperopic shift. Metaregressions did not demonstrate differences between the 3 groups ( <80 mu m, 80-100 mu m, or 100-130 mu m) in any outcomes. circle CONCLUSION: All T/UT-DSAEK thickness groups provided similar visual acuity, pachymetry, endothelial cell count, rejection rate, and rebubbling rate regardless of graft thickness. A hyperopic shift was induced by grafts >100 mu m. (Am J Ophthalmol 2022;240: 170-186. (c) 2022 Elsevier Inc. All rights reserved.)

Automated summary

This study conducted a systematic review and meta-analysis on the efficacy of thin and ultrathin Descemet stripping automated endothelial keratoplasty (T-DSAEK and UT-DSAEK) with different graft thicknesses. The results showed that regardless of graft thickness, postoperative visual acuity, pachymetry, endothelial cell count, rejection rate, and rebubbling rate were similar among different thickness groups. Grafts thicker than 100 μm induced a hyperopic shift.