Comparative study of efficacy and safety between nDSEK and DSEK for bullous keratopathy

Abstract

Background Endothelial keratoplasty has evolved significantly through the utilization of different techniques. However, few studies have compared the clinical outcome between nDSEK (a modified version of the DSEK procedure known as non-Descemet stripping endothelial keratoplasty) and DSEK. This study aims to compare the potential efficacy and safety of nDSEK and DSEK in treating bullous keratopathy. Methods A retrospective comparative study included patients with bullous keratopathy underwent either nDSEK or DSEK between August 2017 and July 2022. These subjects were monitored for a period ranging from 6 to 36 months. The important factors such as best corrected visual acuity (BCVA), endothelial cell density (ECD), endothelial cell loss (ECL), and any complications that occurred during the follow-up period were recorded. Results A total of 52 eyes from 52 patients with bullous keratopathy were included. All subjects underwent either nDSEK (24 eyes) or DSEK (28 eyes). The mean BCVA (logMAR) showed significant improvement from the preoperative measurement of 1.69 ± 0.23 to 0.47 ± 0.22 in nDSEK eyes and from the preoperative 1.67 ± 0.19 to 0.36 ± 0.17 in DSEK eyes respectively at postoperative 12 months. However, there was no statistically significant difference in improvement of BCVA between the nDSEK and DSEK eyes (P = 0.263). The mean donor ECD decreased from the preoperative 2848 ± 108 cells/mm² to 1176 ± 269 cells/mm² (ECL 59%) in nDSEK eyes and from the preoperative 2905 ± 132 cells/mm² to 1235 ± 368 cells/mm² (ECL 57%) in DSEK eyes respectively at postoperative 12 months, with no significant difference between the nDSEK and DSEK eyes (P = 0.185). The occurrence of various complications such as graft dislocation (8.3% in nDSEK eyes vs 3.6% in DSEK eyes, P = 0.891), acute high introcular pressure (4.2% in nDSEK eyes vs 7.1% in DSEK eyes, P = 1), primary graft failure (8.3% in nDSEK eyes vs 7.1% in DSEK eyes, P = 1), graft rejection (8.3% in nDSEK eyes vs 3.6% in DSEK eyes, P = 0.891) did not differ significantly between the nDSEK and DSEK eyes. Conclusions nDSEK eliminated the descemetorrhexis step but yielded a comparable clinical outcome in terms of both effectiveness and safety when compared to DSEK for treating bullous keratopathy.