Overview
This study is designed as a randomised multicentric parallel group pragmatic trial of Descemet Stripping Automated Endothelial Keratoplasty (DSAEK) versus Descemet Membrane Endothelial Keratoplasty (DMEK) in corneal endothelial decompensation. the purpose is to compare the clinical and patient reported outcomes of both therapies across a broad range of indications.
Description
The current problem concerns variability in the provision of corneal endothelial keratoplasties available to patients in Belgium. Some patients receive DSAEK and some (albeit fewer) receive DMEK. Currently the type of corneal graft that a patient receives depends on the treating surgeon opinions.
In this study 220 patients in 11 surgical centres will be recruited and allocated to one of the two surgical options. Both the Ultrathin DSAEK and DMEK grafts will be prepared by corneal banks in the University Hospital of Liege and University Hospital of Antwerp respectively. Patients will be examined preoperatively and postoperatively at 3, 6 and 12 months. Clinical information such as best-corrected visual acuity and refraction will be collected as well as quality of life information based on the EQ-5D-5L and the VFQ 25 assessment tools. These data be used to compare the interventions both on the clinical level as well as from the patient perspective.
Eligibility
Inclusion Criteria:
- Fuchs Endothelial Dystrophy (FED);
- Bullous Keratopathy (BK);
- Other miscellaneous causes of endothelial dysfunction including decompensation of a previous corneal graft;
- Pseudophakic (post cataract surgery);
- Patients over 18 with the capacity to read and to understand the study information and to give informed consent, as well as study quality of life questionnaires;
- Patients willing and capable to attend the 3, 6, and 12-month follow-up appointments.
Exclusion Criteria:
- Inability to provide informed consent;
- Patients unable to attend the proposed follow up;
- Inclusion of the fellow eye in the study;
- Complex surgery combined with multiple pathologies (i.e., glaucoma surgery);
- Other contraindications to lamellar corneas surgery;
- Patients who elect not to participate;
- Patients under 18 years of age;
- Patients that are currently pregnant or breastfeeding;
- Phakic patients with no direct plan to perform cataract surgery.