title: Outcomes of Descemet membrane endothelial keratoplasty, Descemet stripping automated endothelial keratoplasty and penetrating keratoplasty from a single centre study.
abstract: OBJECTIVE
  According to some pioneer surgeons, lamellar endothelial keratoplasty techniques (EK), including Descemet membrane endothelial keratoplasty (DMEK) and Descemet stripping automated endothelial keratoplasty (DSAEK), yield excellent clinical results. However, there is a lack of studies with high levels of evidence and results of large national keratoplasty registers are contradictory. Therefore, two large cohorts of DMEK and DSAEK procedures are compared to a cohort of penetrating keratoplasty (PK).
  
  
  METHODS
  The study reports 868 keratoplasty procedures at a single centre (694 eyes with Fuchs endothelial dystrophy (FED) and 174 with bullous keratopathy (BK)). Patients underwent DMEK (450 eyes), DSAEK (89 eyes), or PK (329 eyes). Postoperative visual acuity, endothelial cell density (ECD), rate of regrafting, and rejections were recorded.
  
  
  RESULTS
  Visual acuity recovers faster and to a greater extent in EK compared to PK. DMEK performs better than DSAEK. ECD drops faster initially for EK compared to PK. In EK the rate of regrafting is higher than in PK (7 % in DMEK, 20 % in DSAEK and 2 % in PK in FED). The rejection rate is lowest following DMEK (7 % after DMEK, 21 % after DSAEK and 18 % after PK in FED).
  
  
  CONCLUSIONS
  In contrast to recent reports from national keratoplasty registers, the overall clinical outcome of EK in FED and BK is superior to PK. Including ocular comorbidities and learning curves, these data reflect a realistic setting for comparing the different keratoplasty techniques. Corneal surgeons may be encouraged to preferentially use DMEK in FED and BK.
authors.affiliation: Eye Center, Albert-Ludwigs-University of Freiburg, Killianstr. 5, D-79106, Freiburg im Breisgau, Germany. sonja.heinzelmann@uniklinik-freiburg.de.
authors.forename: S
authors.initials: S
authors.lastname: Heinzelmann
authors.affiliation: Eye Center, Albert-Ludwigs-University of Freiburg, Killianstr. 5, D-79106, Freiburg im Breisgau, Germany.
authors.forename: D
authors.initials: D
authors.lastname: Böhringer
authors.affiliation: Eye Center, Albert-Ludwigs-University of Freiburg, Killianstr. 5, D-79106, Freiburg im Breisgau, Germany.
authors.forename: P
authors.initials: P
authors.lastname: Eberwein
authors.affiliation: Eye Center, Albert-Ludwigs-University of Freiburg, Killianstr. 5, D-79106, Freiburg im Breisgau, Germany.
authors.forename: T
authors.initials: T
authors.lastname: Reinhard
authors.affiliation: Eye Center, Albert-Ludwigs-University of Freiburg, Killianstr. 5, D-79106, Freiburg im Breisgau, Germany.
authors.forename: P
authors.initials: P
authors.lastname: Maier
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001768:Blister / Q000503:physiopathology / Q000601:surgery*; D002452:Cell Count; D003316:Corneal Diseases / Q000503:physiopathology / Q000601:surgery*; D055954:Corneal Endothelial Cell Loss / Q000503:physiopathology; D003886:Descemet Membrane / Q000601:surgery*; D057111:Descemet Stripping Endothelial Keratoplasty; D004728:Endothelium, Corneal / Q000473:pathology; D005260:Female; D005642:Fuchs' Endothelial Dystrophy / Q000503:physiopathology / Q000601:surgery*; D006085:Graft Survival / Q000502:physiology; D006801:Humans; D015948:Keratoplasty, Penetrating; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D016896:Treatment Outcome; D014792:Visual Acuity / Q000502:physiology
keywords: Cornea; DMEK; DSAEK; Keratoplasty; PK