Comparison and Correlation of the Donor–Recipient Interface Changes and Visual Outcomes Between nDSEK and DSEK

TL;DR

This study compares two corneal transplant techniques, nDSEK and DSEK, finding that nDSEK causes more interface particles and haze but similar visual outcomes and graft stability.

Contribution

The study provides new comparative data on interface changes and visual outcomes between nDSEK and DSEK.

Findings

nDSEK had significantly higher interface particle density and haze compared to DSEK.

Visual acuity improved similarly in both nDSEK and DSEK groups.

Graft dislocation rates were comparable between the two techniques.

Abstract

Purpose: This study aimed to compare the donor–recipient interface changes between non-Descemet stripping endothelial keratoplasty (nDSEK) and Descemet stripping endothelial keratoplasty (DSEK) and assess their correlation with the postoperative best spectacle-corrected visual acuity (BCVA).

Methods: This retrospective study collected clinical data on patients with corneal endothelial decompensation who underwent either nDSEK or DSEK between August 2019 and April 2023. The donor–recipient interface particle density, interface haze, visual outcome, and graft dislocation were compared between nDSEK and DSEK groups.

Results: A total of 66 eyes from 66 patients (nDSEK n: 31 eyes and DSEK n: 35 eyes) were included. At 12 months postoperatively, nDSEK had a mean interface particle density of 631.97 ± 143.95 particles/mm2, significantly higher than DSEK's 518.20 ± 121.72 particles/mm2 (p=0.001). The interface haze was also greater in nDSEK (78.16 ± 13.74) compared with DSEK (64.21 ± 14.78) (p < 0.001). BCVA improved similarly in both groups, with nDSEK changing from 1.92 ± 0.26 to 0.37 ± 0.11 and DSEK from 1.85 ± 0.24 to 0.34 ± 0.10 (p=0.149). Correlation analysis revealed a significant association between interface particle density and interface haze in both the nDSEK (correlation coefficient: 0.716, p < 0.001) and DSEK (correlation coefficient: 0.618, p < 0.001) groups. However, there was no significant correlation between interface particle density and postoperative BCVA for either the nDSEK (correlation coefficient: −0.028, p=0.883) or DSEK (correlation coefficient: 0.111, p=0.525) group. Similarly, no significant correlation was found between interface haze and postoperative BCVA in both groups (nDSEK: correlation coefficient: −0.080, p=0.670 and DSEK: correlation coefficient: −0.210, p=0.227). Graft dislocation rates were comparable: 3.2% in nDSEK and 2.9% in DSEK (p=0.931).

Conclusion: nDSEK exhibited more interface particles and haze than standard DSEK, but visual outcomes and graft attachment were similarly effective.

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