Patients Equally Pleased With Different Keratoplasty Approaches

By David Douglas

May 13, 2019

NEW YORK (Reuters Health) - Although the Descemet Endothelial Thickness Comparison Trial (DETECT) showed better visual acuity with a newer, more demanding corneal transplantation method, this did not translate into greater patient satisfaction, according to a secondary analysis of outcome data.

As Dr Jennifer Rose-Nussbaumer explained in an email to Reuters Health, "Vision-related quality-of-life improves in patients undergoing a unilateral endothelial keratoplasty with either ultrathin Descemet stripping automated endothelial keratoplasty (UT-DSAEK) or Descemet membrane endothelial keratoplasty (DMEK)."

In a May 2 online paper in JAMA Ophthalmology, Dr. Rose-Nussbaumer of the University of California, San Francisco, and colleagues report on 38 participants in the DETECT trial, including 19 who were treated with UT-DSAEK and 19 who underwent the technically more challenging DMEK.

More eyes were involved in the original study, the researchers point out, but data following second eye surgery were excluded "because it would be difficult to assess which eye was contributing to vision-related quality of life."

The team analyzed responses to the National Eye Institute (NEI) Visual Function Questionnaire-39 (VFQ-39) administered at baseline and at three months in 38 eyes and at 12 months postoperatively in 26 eyes. The VFQ-39, say the investigators, "has been used widely to evaluate vision-related quality-of-life outcomes in various ocular diseases."

Overall, study participants experienced a 9.1-point improvement in NEI VFQ-39 composite score at 3 months (on a 100-point scale) compared with baseline and an 11.6-point improvement at 12 months compared with baseline.

After controlling for baseline scores, eyes randomized to DMEK had 0.9 points more improvement in NEI VFQ-39 composite score at 3 months compared with UT-DSAEK. However, this difference was not significant.

"Although DETECT found that patients undergoing DMEK had approximately 1.4 lines better visual acuity on average at 12 months, we were unable to find a difference in quality of life, therefore, corneal surgeons who have not yet adopted DMEK may not be motivated to learn this new challenging technique," Dr. Rose-Nussbaumer said.

Commenting by email, Dr. Alan Sugar of the University of Michigan, Ann Arbor, whose editorial was published with the paper, told Reuters Health, "This study confirmed improvement in quality of life with both ultrathin Descemet stripping (DSAEK) and Descemet membrane (DMEK) corneal transplants, although the DMEK results were minimally better."

"It will be interesting, as these outcomes were only for the first eye surgery of each patient, to see how much additional benefit there is from second eye surgery," he added.


JAMA Ophthalmol 2019.