Eyeworld

76 | EYEWORLD | APRIL 2023 C ORNEA References 1. Matsou A, et al. Microthin Descemet stripping automat- ed endothelial keratoplasty versus Descemet membrane endothelial keratoplasty: a randomized clinical trial. Cornea. 2021;40:1117–1125. 2. Rose-Nussbaumer J, et al. Descemet endothelial thickness comparison trial: two-year results from a randomized trial comparing ultrathin Descemet stripping automated endothelial keratoplasty with Descemet membrane endothelial keratoplasty. Ophthalmology. 2021;128:1238–1240. "DSAEK still has a solid role in corneal transplantation, and therefore techniques and training emphasis are important. One of the driving forces for DMEK is the result of two randomized controlled trials that demonstrated that DMEK outperformed ultrathin DSAEK in patients with Fuchs and bullous keratopathy in terms of vision at 1 year and recovery time. 1 One of those trials showed DMEK still giving better visual acuity at 2 years after surgery than ultrathin DSAEK, 2 " Dr. Chamberlain said. He noted, however, that the trials focused on less complicated eyes. "There are fewer high-stan- dard publications rigorously assessing DMEK's long-term performance in more complicated eyes. These eyes create surgical challenges for successfully completing DMEK, and therefore DSAEK may still be the best approach." Dr. Venkateswaran said this is how she approaches her cases. "In my straightforward cases with endothelial dysfunction (i.e., Fuchs dystrophy or pseudophakic bullous keratopa- thy), I will perform DMEK. But since I practice in a tertiary care referral center where I'm comanaging very sick eyes with multiple ocular comorbidities and previous ocular surgeries (i.e., prior glaucoma surgeries, prior vitrec- tomies, iris defects, scleral fixated or anterior chamber IOL placement), I tend to perform more DSAEK as I think these complex eyes fare continued from page 74 Anterior segment OCT of DSAEK Source: Clara Chan, MD A 50% bubble on postop day 1 of a DSAEK case Source: Clara Chan, MD Attached DSAEK graft with air bubble Source: Nandini Venkateswaran, MD Loading of DSAEK graft onto EndoSerter (CorneaGen) Source: Nandini Venkateswaran, MD

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