Current Treatment Options for Fuchs Endothelial Dystrophy by Claus Cursiefen & Albert S. Jun

Author:Claus Cursiefen & Albert S. Jun
Language: eng
Format: epub
Publisher: Springer International Publishing, Cham

8.9 Conclusions

Many authors claim that final visual acuity following DSAEK is suboptimal, with fewer eyes than expected achieving 20/20 vision, possibly because of the presence of a stromal interface [1–3, 17]. In comparison to most of the DSAEK series published to date, DMEK has shown a decisive improvement in terms of speed of visual recovery, percentage of patients achieving 20/20 vision, as well as rate of immunologic rejection [6–9]. However, ease of graft preparation, manipulation, delivery, and attachment, as well as feasibility of the procedure for eyes with complicated anatomy or poor intraoperative visualization, limits the use of DMEK even in the hands of an experienced corneal surgeon. Ideally, every surgeon would like to use grafts that can be manipulated as easily as DSAEK ones are, but produce the same visual results of DMEK grafts. UT-DSAEK is a technique aimed at reproducibly preparing DSAEK grafts usually thinner than 100 μm, with a double- or single microkeratome pass. In conclusion, UT-DSAEK is a procedure that shares the improved visual outcome and lower immunologic rejection rate of DMEK over DSAEK, while minimizing all types of postoperative complications. In addition, similarly to DSAEK and unlike DMEK, UT-DSAEK can be performed in all types of eyes, even in those with complicated anatomy (i.e., free communication between the anterior chamber and vitreous cavity as in aphakia, the presence of anterior chamber IOLs, etc.) or poor anterior chamber visualization [6, 9]. Finally, unlike DMEK grafts, UT-DSAEK grafts can be routinely dissected even by relatively inexperienced eye bank technicians and easily evaluated, thus reducing tissue waste and further improving the quality of tissue to be transplanted.

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