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Descemet membrane endothelial keratoplasty and ultrathin Descemet stripping automated endothelial keratoplasty are both established approaches to corneal endothelial failure. A randomized clinical trial compared visual quality after the two techniques in patients with Fuchs endothelial dystrophy. DMEK produced lower posterior corneal higher-order aberrations, better contrast sensitivity and lower straylight during early follow-up. By one year, many of these differences had narrowed, and vision-related quality of life improved substantially in both groups. The findings suggest that the main advantage of DMEK may be faster optical recovery and a more physiologically restored posterior corneal surface rather than a dramatic late difference in patient-reported quality of life. For HCPs, procedure selection should take into account surgeon experience, disease severity, graft handling, rebubbling risk and the patient's visual expectations. The study is directly relevant to AIOC's cornea focus on DMEK and endothelial keratoplasty refinement.

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Descemet membrane endothelial keratoplasty and ultrathin Descemet stripping automated endothelial keratoplasty are both established approaches to corneal endothelial failure. A randomized clinical trial compared visual quality after the two techniques in patients with Fuchs endothelial dystrophy. DMEK produced lower posterior corneal higher-order aberrations, better contrast sensitivity and lower straylight during early follow-up. By one year, many of these differences had narrowed, and vision-related quality of life improved substantially in both groups. The findings suggest that the main advantage of DMEK may be faster optical recovery and a more physiologically restored posterior corneal surface rather than a dramatic late difference in patient-reported quality of life. For HCPs, procedure selection should take into account surgeon experience, disease severity, graft handling, rebubbling risk and the patient's visual expectations. The study is directly relevant to AIOC's cornea focus on DMEK and endothelial keratoplasty refinement.
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