Comparison of DSAEK, U-DSAEK and DMEK

1. DSAEK Vs. DMEK
and ongoing
debates in
endothelial
keratoplasty
Haitham Al Mahrouqi
Senior Fellow, Cornea and Anterior
Segment
University of Auckland

2. History
Oman J Ophthalmol. 2013 Sep-Dec; 6(Suppl 1): S12–S17

3. Drivers of
lamellar
keratoplasty
Faster recovery
Better visual results
Lower rejection rates

4. DALK VS. PK

5. Endothelial
keratoplasty

7. Posterior
lamellar
keratoplasty
First described by Gerrit Melles in
1998
Thick graft through large 9mm
sclerocorneal tunnel.
2004: DSAEK
2006: DMEK

8. - Chilibeck, C. M. , Brookes, N. H. , Gokul, A. , Kim, B. Z. , Twohill, H. C. , Moffatt, S. L. , Pendergrast, D. G. & McGhee, C. J. (9000). Changing Trends in
Corneal Transplantation in Aotearoa/New Zealand, 1991 to 2020. Cornea, Publish Ahead of Print , doi: 10.1097/ICO.0000000000002812.
- Price MO, Feng MT, Price FWJ. Endothelial Keratoplasty Update 2020. Cornea. 2021;40(5):541-547. doi:10.1097/ico.0000000000002565

9. Reasons for
faster
adoption of
DSAEK
Tissue preparation by the eye bank
Ease of handling of the lamellar graft
Aspects of recipients’ ocular anatomy
Intra-operative complications
Early visual recovery compared to PK
Survival of the graft.

10. Tissue preparation

11. Tissue
preparation:
• Thin: <131um
• Ultra-thin: around 100um
• Nano < 100um
Ophthalmology. 2013 Jun;120(6):1186-94

12. Ease of handling: DMEK
Endothelial Keratoplasty Chapter 131 Surgical Technique for DMEK
Kevin J. Shah, Michael D. Straiko, M. Greiner, Published 2016,Medicine

13. Ease of handling: DSAEK

14. Anatomical
consideration
• Corneal scarring
• Post PK
• Glaucoma valves
• Vitrectomized eyes
• Large PI

15. • 15 eyes who underwent DSAEK in one and and DMEK in the
other for FECD.
• Re-bubbling: DSAEK 7%, DMEK 33%

16. Thin, thinner,
thinnest

17. • Thickness 60-90um
• 25 eyes in each arm

19. Rejection and
failure
DMEK (%) DSAEK (%)
Primary graft
failure
3.8 0.8
Rejection (12
months)
5.5 8.2
Cell loss (6
months)
790±360 cells 762±418 cells
• Included 10 studies
• 947 eyes

20. Take home message
DMEK DSAEK
Tissue preparation Difficult Easier
Tissue handling Difficult Easier
Recipient abnormal eye’s anatomy Difficult Easier
Visual outcome Excellent Very good
Complications Higher Lower
Rejection Lower Higher
Primary failure Higher Lower
Survival Similar Similar

21. Thank you