This study compared corneal higher-order aberrations (HOAs) after ultrathin Descemet stripping automated endothelial keratoplasty (UT-DSAEK) vs Descemet membrane endothelial keratoplasty (DMEK).

Study design

Study participants had a damaged or diseased endothelium due to Fuchs endothelial dystrophy or pseudophakic bullous keratopathy. Fifty eyes (38 patients) were randomized to UT-DSAEK or DMEK. The main outcome—HOAs of the anterior and posterior cornea—was measured with Scheimpflug imaging.

Outcomes

Overall, DMEK resulted in less posterior corneal coma (P ≤ 0.003) and total HOA (P ≤ 0.001) than UT-DSAEK. Posterior trefoil, secondary astigmatism, and tetrafoil were also lower in the DMEK group. Total posterior corneal HOA tracked with best spectacle-corrected visual acuity (BSCVA) at 12 months. Anterior surface HOA was similar with both procedures.

Limitations

Since HOAs were a prespecified secondary outcome of the DETECT study, this trial may not have been powered to distinguish all differences.

Clinical significance

These findings show that DMEK results in the reduction of posterior corneal HOAs and may account for the better visual acuity observed after DMEK.