This systematic review and meta-analysis reviewed published evidence comparing two endothelial corneal transplants techniques; Descemet membrane endothelial keratoplasty (DMEK) and Descemet stripping automated endothelial keratoplasty (DSEAK). DMEK involves transplanting Descemet membrane with endothelial cells without any overlying stroma. In DSAEK parts of posterior stroma are transplanted together with Descemet membrane and endothelial cells. DMEK is a more challenging surgical technique with longer learning curve. However, six months postoperatively DMEK eyes had significantly better best-spectacle corrected visual acuity, thinner post-operative central corneal thickness and surgery resulted in higher patient satisfaction compared to DSAEK. There were no statistically significant differences in endothelial cell losses between two procedures. Postoperatively DMEK eyes were more likely to require re-bubbling compared to DSEAK, and tended to have lower rejection rates, although rejection rates for both procedures were low. This study did not review specific surgical indications, which might determine which procedure will be more beneficial in a given clinical scenario. The article also did not include any randomised controlled trials, as these are lacking. Reviewed evidence points to DMEK being a superior procedure to DSEAK in terms of final best-corrected visual acuity, but caries a higher risk of postoperative re-bubbling. 

Systematic review and meta-analysis of clinical outcomes of descemet membrane endothelial keratoplasty versus descemet stripping endothelial keratoplasty/descemet stripping automated endothelial keratoplasty.
Singh A, Zarei-Ghanavati M, Avadhanam V, Liu C.
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Magdalena Popiela

Royal Gwent Hospital, Cardiff, UK.

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