Comparative study of effectiveness and safety between non-Descemet stripping endothelial keratoplasty and Descemet stripping endothelial keratoplasty for endothelial decompensation

Abstract

Purpose: To compare the potential effectiveness and safety of non-Descemet stripping endothelial keratoplasty (nDSEK) and Descemet stripping endothelial keratoplasty (DSEK) in treating endothelial decompensation.

Methods: A retrospective comparative analysis was conducted on patients with endothelial decompensation who underwent either nDSEK or DSEK procedures between August 2017 and January 2024. Participants were observed for a minimum duration of 12 months. The study documented key variables like best corrected visual acuity (BCVA), endothelial cell density (ECD), endothelial cell loss (ECL), and any issues that occurred during the follow-up period.

Results: A total of 85 eyes from 85patients (nDSEK n = 40 eyes, DSEK n = 45 eyes) were ultimately included in the study for analysis based on the inclusion and exclusion criteria. The mean BCVA (logMAR) showed significant improvement from the preoperative measurement of 1.66 ± 0.26 to 0.37 ± 0.11 in nDSEK eyes and from the preoperative 1.68 ± 0.24 to 0.36 ± 0.10 in DSEK eyes, respectively, at postoperative 12 months. However, there was no statistically significant difference in the improvement of BCVA between the nDSEK and DSEK eyes (p = 0.605). The mean donor ECD decreased from the preoperative 2,814 ± 85 cells/mm² to 1,195 ± 216 cells/mm² (ECL 57.5%) in nDSEK eyes and from the preoperative 2,889 ± 125 cells/mm² to 1,266 ± 285 cells/mm² (ECL 56.2%) in DSEK eyes, respectively, at postoperative 12 months, with no significant difference between the nDSEK and DSEK eyes (p = 0.192). The occurrence of various complications (e.g., graft dislocation, acute hypertension, primary graft failure, graft rejection) was comparable between nDSEK and DSEK eyes.

Conclusion: nDSEK eliminated the descemetorhexis step but yielded a comparable clinical outcome in effectiveness and safety compared to DSEK for treating endothelial decompensation.

Keywords: Descemet stripping endothelial keratoplasty; endothelial decompensation; endothelial keratoplasty; non-Descemet stripping endothelial keratoplasty; treatment.

Figure 1

Representative slit-lamp microscope and AS-OCT photographs after completion of successful surgery. The cornea appeared transparent with no visible differences between the nDSEK (A) and DSEK (B) eyes (when examined using a slit-lamp. top), donor lenticule adhered to recipient bed well (AS-OCT, bottom); nDSEK, non-Descemet stripping endothelial keratoplasty; DSEK, Descemet stripping endothelial keratoplasty.

Figure 2

The comparison of BCVA and ECD after surgery shows variations between nDSEK and DSEK eyes at different time intervals. (A) BCVA was found to be improved and (B) ECD decreased with time, but there were no statistically significant differences observed for BCVA (p = 0.605) and ECD (p = 0.192) between nDSEK and DSEK eyes at the same time point. BCVA, best-corrected visual acuity; LogMAR, logarithm of minimal angle of resolution; ECD, endothelial cell density;nDSEK, non-Descemet stripping endothelial keratoplasty; DSEK, Descemet stripping endothelial keratoplasty.