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Comparative evidence consistently shows that Descemet membrane endothelial keratoplasty (DMEK) can provide faster and better visual rehabilitation than Descemet stripping automated endothelial keratoplasty (DSAEK), although the procedures have different technical demands. A systematic review and meta-analysis comparing the two techniques found better spectacle-corrected visual acuity and patient satisfaction after DMEK, while endothelial cell density outcomes were not significantly different overall. One important trade-off was a higher rebubbling rate with DMEK. This balance is clinically relevant in modern endothelial keratoplasty practice. DMEK's thinner, more anatomically selective graft can improve optical quality, but graft unfolding, positioning, detachment management, and learning-curve issues can affect early postoperative care. Surgeons therefore need to consider not only visual outcomes but also recipient anatomy, surgeon experience, and the likelihood of postoperative interventions. The evidence supports DMEK as a highly effective option when the goal is rapid and high-quality visual recovery, while recognizing that DSAEK remains an important and often more forgiving technique in selected settings.
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Comparative evidence consistently shows that Descemet membrane endothelial keratoplasty (DMEK) can provide faster and better visual rehabilitation than Descemet stripping automated endothelial keratoplasty (DSAEK), although the procedures have different technical demands. A systematic review and meta-analysis comparing the two techniques found better spectacle-corrected visual acuity and patient satisfaction after DMEK, while endothelial cell density outcomes were not significantly different overall. One important trade-off was a higher rebubbling rate with DMEK. This balance is clinically relevant in modern endothelial keratoplasty practice. DMEK's thinner, more anatomically selective graft can improve optical quality, but graft unfolding, positioning, detachment management, and learning-curve issues can affect early postoperative care. Surgeons therefore need to consider not only visual outcomes but also recipient anatomy, surgeon experience, and the likelihood of postoperative interventions. The evidence supports DMEK as a highly effective option when the goal is rapid and high-quality visual recovery, while recognizing that DSAEK remains an important and often more forgiving technique in selected settings.
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