Clinical Outcomes After Ultrathin Descemet Stripping Automated Endothelial Keratoplasty Versus Descemet Membrane Endothelial Keratoplasty for Fuchs Endothelial Corneal Dystrophy: A Systematic Review and Meta-Analysis

In Fuchs endothelial dystrophy (FED), the corneal endothelial layer undergoes progressive degenerative changes leading to a reduction in endothelial cell count and subsequent visual impairment. Descemet membrane endothelial keratoplasty (DMEK) and ultrathin Descemet stripping automated endothelial keratoplasty (UT-DSAEK) are two established surgical approaches for the management of FED. This meta-analysis aims to compare postoperative clinical outcomes between DMEK and UT-DSAEK in adult patients with FED. A literature search was conducted in major peer-reviewed electronic databases. Best-corrected visual acuity (BCVA) served as the primary outcome, while endothelial cell density (ECD) and postoperative complications were evaluated as secondary outcomes. Compared with UT-DSAEK, DMEK demonstrated a tendency toward better BCVA at one year, although it was also associated with a higher likelihood of requiring re-bubbling. No clear differences were observed between the two techniques regarding ECD at 12 months, while complication rates varied between studies. Overall, DMEK showed more favorable visual outcomes, whereas UT-DSAEK presented a lower complication burden. Although complications following DMEK are generally manageable, some may necessitate additional surgical procedures. Both techniques remain effective options for corneal surgeons treating patients with FED.