Research published in The Journal of Cornea and External Disease revealed promising results of Descemet's stripping only (DSO) treatment for Fuchs endothelial corneal dystrophy (FECD).
Give me some background first.
FECD is the most common of corneal endothelial dystrophies (CEDs), often effectively managed with Descemet membrane endothelial keratoplasty (DMEK).
However, DMEK is limited by several factors relating to the donor Descemet membrane graft.
DSO, a popular procedure in recent years, does not use grafts. Instead, it removes the patient’s Descemet membrane to allow surrounding healthy endothelial cells to move into the Descemet layer.
Now, talk about the study.
Study authors aimed to compare preoperative and postoperative data on DSO patients over a follow-up period up to 7 years. This included:
- Best-corrected visual acuity (BCVA)
- Central corneal thickness (CCT)
- Central endothelial cell count (ECC)
- Failure rate
Who was included in the study?
This retrospective study used 26 eyes of 20 patients who underwent DSO for FECD. All patients were treated at the Rothschild Foundation Hospital in Paris, France, between December 2015 and November 2022.
Findings?
There were 22 eyes that responded to DSO, 91% of which were female.
The mean BCVA significantly improved from 0.3±0.17 logMAR preoperatively to 0.9±0.13 logMAR postoperatively. The mean postoperative CCT decreased significantly from 588±41 µm to 546±50 µm.
Tell me more.
Patients who responded well to DSO had a central guttata and a peripheral cell count greater than 1000 cells/mm2.
Removal of less than 4 mm of the central Descemet membrane and use of the peeling technique also contributed to the success of the operation.
Anything else?
Four eyes did not respond to DSO and successfully underwent DMEK surgery after developing persistent corneal edema three months post-operation.
Possible factors leading to nonresponse include peripheral cell count, peripheral cell polymegathism, peripheral cell polymorphism, and gender— although the differences of these characteristics between responder and nonresponder groups was not statistically significant.
Therefore, more research is needed with larger samples to further evaluate the causes.
Limitations?
Previous research has suggested that postoperative use of Rho-kinase inhibitors can assist in recovery from DSO.
Although the failure rate of this study was higher than in previous studies, these differences may be due to imperfect surgical techniques rather than the use of Rho-kinase inhibitors.
Expert opinion?
According to study authors, “this stable clinical outcome over the years is encouraging and suggests that DSO can provide long-term benefits for selected patients with FECD, potentially delaying the need for DMEK surgery.”
Take home.
DSO has been demonstrated to be a long-term solution for certain FECD patients. Further research can reveal more details to help identify ideal patients for DSO.