Comparison of ultrathin manual and automated stripping of the endothelium in Fuchs endothelial dystrophy

AbstractPurpose This study compares two techniques of preparation of the endothelial graft: the DSAEK (Descemet Stripping Automated Endothelial Keratoplasty) and an ultrathin endothelial graft manually prepared.Methods A randomised prospective study is being conducted at the Hospital of Rouen, France. Patients presenting a Fuchs dystrophy are included in two groups. Patients from Group A receive an ultrathin manually prepared endothelial graft and patients from Group B receive a DSAEK. In order to improve the power of our study, one patient from each group is grafted on the same day, with a corneal endothelium coming from the same donor. Improvement of visual acuity is the main outcome measure. Vitality of the graft, refractive modifications induced by surgery and complications are also studied.Results Currently, 22 patients with a follow up of 6 months have been included. At inclusion, patients from Group A and B were not statistically different. Six months after surgery, mean best corrected visual acuity has significantly improved in both groups but is statistically better in Group A (0,18 logMar in Group A versus 0,31 logMar in Group B (p<0,05)). Mean endothelial cell density is 1686 cells in Group A statistically more than in Group B (1260 cells) p<0,05. There were no refractive modifications in either group. There was no episode of graft rejection.Conclusion Ultrathin endothelial graft seems to give better results than DSAEK in Fuchs dystrophy in terms of visual acuity and endothelial cell density. It could be a good alternative to DMEK (Descemet membrane endothelial keratoplasty) because it is easier to prepare and inject than DMEK and should then be favoured when DMEK is not possible.