Descemet stripping automated endothelial keratoplasty versus descemet membrane endothelial keratoplasty: a meta-analysis

Purpose To evaluate the efficacy and safety of descemet stripping automated endothelial keratoplasty (DSAEK) compared with descemet membrane endothelial keratoplasty (DMEK). Methods Databases including PubMed, EMBASE, and Cochrane Library were searched to find studies that compared DSAEK and DMEK outcomes. Efficacy parameters were the postoperative best-corrected visual acuity (BCVA) and spherical equivalent (SE). Safety parameters were postoperative endothelial cell loss (ECL), air injection (rebubbling), graft failure, graft rejection, and high intraocular pressure (IOP). Results from last visit were pooled for the analyses because the follow-up ranged from 3 to 24 months. Results A total of 7 trials including 433 eyes were selected for this meta-analysis. BCVA was reported in all 7 studies, ECL% and rebubbling rate were reported in 6, and the remaining outcomes were reported in only 3 or 2 studies. Postoperative logMAR BCVA was significantly better for DMEK than that for DSAEK (P < 0.00001). More patients achieved the postoperative BCVA >= 20/25 and 20/20 in DMEK group than that in DSAEK(P > 0.001), whereas the proportion of patients whose postoperative BCVA >= 20/40 and the amount of SE did not differ statistically (P = 0.32 and P = 0.50, respectively). The DSAEK group has a significantly lower frequency of rebubbling than the DMEK group (P < 0.0001). The postoperative ECL%, graft failure, graft rejection, and high IOP were comparable between the 2 groups (all P values > 0.05). Conclusions Our meta-analysis suggests that DMEK provided better visual outcomes with similar safety when compared to DSAEK. Given the limited sample size, further investigations are needed to validate these findings.