Title : Eye precut versus surgeon-cut tissue graft for descemet stripping automated endothelial keratoplasty (DSAEK): A systematic review and meta-analysis
Abstract:
Objective: To compare the outcomes of eye-bank precut versus surgeon-cut tissue graft for patients undergoing Descemet Stripping Automated Endothelial Keratoplasty (DSAEK).
Methods: A systematic review and meta-analysis were performed as per the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) Guidelines. A search of electronic information was conducted to identify all comparative studies of eye-bank precut versus surgeon-cut tissue graft for DSAEK. Endothelial cell loss (cells/mm²), rebubbling rate and best corrected visual acuity (BCVA) were primary outcome measures. Secondary outcome measures included postoperative corneal thickness (µm), complications and cost analysis. Fixed effects modelling was used for the analysis.
Results: Six studies enrolling 548 grafts patients for DSAEK were identified. Although endothelial cell loss was not significantly different between both groups at 6 months postoperatively (Mean Difference [MD] = -0.29, P = 0.97), there was a significant difference in endothelial cell loss at 1 year (MD = -4.53, P = 0.02) favouring the eye-bank group. Similarly, there was a statistically significant difference in the post-operative BCVA (MD = -0.01, P = 0.007) favouring the eye-bank precut group. There was no significant difference between eye-bank precut and surgeon-cut graft groups in terms of rebubbling rate (Odds Ratio [OR] = 1.70, P = 0.25) and graft failure rate (OR = 1.04, P = 0.97). Similarly, no statistically significant difference was noted regarding postoperative corneal thickness and complications, including increased intraocular pressure and the development of Irvine-Gass Syndrome. Cost analysis demonstrated that lower surgical expenses for the surgeon-cut tissue grafts.
Conclusion: Eye-bank is an excellent alternative to surgeon-cut tissue graft for patients undergoing DSAEK as it yields a similar rebubbling rate and improved endothelial cell loss.
Audience Take Away:
- Several comparative studies have assessed the outcomes of EBP and SC tissue graft for patients undergoing DSAEK. This is the first systematic review and meta-analysis in the literature to evaluate which preparation is more effective.
- There was no statistically significant difference was noted regarding postoperative corneal thickness and complications between the two methods.
- Eye-bank is an alternative to surgeon-cut tissue graft for patients undergoing DSAEK.
