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

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 m) 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 m (range 26-50 m). 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.