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1

Droutsas, Konstantinos, Myrsini Petrelli, Dimitrios Miltsakakis, Konstantinos Andreanos, Anastasia Karagianni, Apostolos Lazaridis, Chrysanthi Koutsandrea, and George Kymionis. "Visual Outcomes of Ultrathin-Descemet Stripping Endothelial Keratoplasty versus Descemet Stripping Endothelial Keratoplasty." Journal of Ophthalmology 2018 (November 1, 2018): 1–5. http://dx.doi.org/10.1155/2018/5924058.

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Purpose. To examine the impact of graft thickness (GT) on postoperative visual acuity and endothelial cell density after ultrathin-Descemet stripping automated endothelial keratoplasty (UT-DSAEK) versus conventional DSAEK. Methods. The medical records of all patients who underwent DSAEK at our institute during a 2-year period were reviewed. After excluding subjects with low visual potential, 34 eyes were divided into two groups based on the postoperative GT as measured with anterior segment optical coherence tomography (AS-OCT): an UT-DSAEK group (GT ≤ 100 μm, n=13 eyes) and a DSAEK group (GT > 100 μm, n=21 eyes). The groups were compared with regard to best-corrected visual acuity (BCVA), subjective refraction, central corneal thickness (CCT), GT, and endothelial cell density (ECD). Results. Preoperative BCVA (logMAR) was 1.035 ± 0.514 and 0.772 ± 0.428 for UT-DSAEK and DSAEK, respectively (P=0.072). At 6 months postoperatively, BCVA was 0.088 ± 0.150 following UT-DSAEK and 0.285 ± 0.158 following DSAEK (P=0.001). Conclusion. DSAEK grafts with a thickness under 100 μm offered better visual outcomes during the early postoperative period.
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2

Romano, Vito, Luca Pagano, Kunal A. Gadhvi, Giulia Coco, Mitchell Titley, Matthew Thomas Fenech, Stefano Ferrari, Hannah J. Levis, Mohit Parekh, and Stephen Kaye. "Clinical outcomes of pre-loaded ultra-thin DSAEK and pre-loaded DMEK." BMJ Open Ophthalmology 5, no. 1 (October 2020): e000546. http://dx.doi.org/10.1136/bmjophth-2020-000546.

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ObjectiveTo compare clinical outcomes and complications between pre-loaded ultra-thin Descemet stripping automated endothelialkeratoplasty (pl-UT-DSAEK) and pre-loaded Descemet membrane endothelial keratoplasty (pl-DMEK).Methods and analysisComparative study in patients with endothelial dysfunction associated with Fuchs endothelial corneal dystrophy and pseudophakic bullous keratopathy who underwent pl-UT-DSAEK or pl-DMEK transplants. For both groups, the tissues were pre-loaded at the Fondazione Banca degli Occhi del Veneto (Venice, Italy) and shipped to The Royal Liverpool University Hospital (Liverpool, UK). Best corrected visual acuity (BCVA) and re-bubbling rates were the main outcome measures.Results56 eyes of 56 patients were included. 31 received pl-UT-DSAEK and 25 received pl-DMEK. At 12 months, BCVA (LogMAR) was significantly better for pl-DMEK (0.17±0.20 LogMAR) compared with pl-UT-DSAEK (0.37±0.37 LogMAR, p<0.01). The percentage of people that achieved ≥20/30 was significantly higher in the pl-DMEK group. The rate of re-bubbling, however, was significantly higher for pl-DMEK (44.0%) than for Pl-UT-DSAEK (12.9%), p<0.01.ConclusionPl-DMEK offers better BCVA than pl-UT-DSAEK. The higher re-bubbling rate associated with pre-loaded DMEK is of concern.
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3

Castellucci, Massimo, Costanza Novara, Alessandra Casuccio, Giovannni Cillino, Carla Giordano, Valentina Failla, Vincenza Bonfiglio, Maria Vadalà, and Salvatore Cillino. "Bilateral Ultrathin Descemet’s Stripping Automated Endothelial Keratoplasty vs. Bilateral Penetrating Keratoplasty in Fuchs’ Dystrophy: Corneal Higher-Order Aberrations, Contrast Sensitivity and Quality of Life." Medicina 57, no. 2 (February 3, 2021): 133. http://dx.doi.org/10.3390/medicina57020133.

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Background and Objectives: The objective of this paper is to compare the visual outcomes and quality of life (QoL) after bilateral ultrathin Descemet’s stripping automated endothelial keratoplasty (UT-DSAEK) with bilateral penetrating keratoplasty (PK) for Fuchs’ endothelial dystrophy (FED). Materials and Methods: Retrospective comparative cohort study, including 11 patients with FED who underwent bilateral PK and 13 patients with FED who underwent bilateral UT-DSAEK. All patients were already pseudophakic or had undergone a combined cataract procedure. The main outcomes were corrected distance visual acuity (CDVA) corneal higher-order aberrations (HOAs), contrast sensitivity (CS) and quality of life (QoL). Results: The mean follow-up after the second eye surgery was 32.5 ± 10.2 months in PK and 19.6 ± 8.6 months in UT-DSAEK patients. The CDVA in the UT-DSAEK group was significantly better than in the PK one (0.18 ± 0.07 vs. 0.35 ± 0.16 logMAR, p < 0.0001). The mean anterior corneal total HOAs of the central 5 mm were significantly lower in UT-DSAEK eyes than in PK eyes (0.438 ± 0.078 µ and 1.282 ± 0.330 µ respectively, p < 0.0001), whilst the mean posterior total HOAs did not differ between groups (0.196 ± 0.056 µ and 0.231 ± 0.089 µ, respectively, p = 0.253). The CS was lower at 0.75 and 1.5 cycles/degree in P the K group when compared to the DSAEK one (p = 0.008 and 0.005, respectively). The QoL scores by the NEI RQL-42 test exhibited better values in DSAEK patients in 9 out of 13 scales. Conclusion: Our study confirms that UT-DSAEK provides a better visual function in terms of CDVA and CS, together with lower HOAs, when compared to PK. Hence, the vision-related QoL, binocularly evaluated by the NEI RQL-42 items, indicates a higher satisfaction in UT-DSAEK eyes.
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4

Torras-Sanvicens, Josep, Irene Blanco-Domínguez, José-María Sánchez-González, Rahul Rachwani-Anil, Juan-Felipe Spencer, Noelia Sabater-Cruz, Jorge Peraza-Nieves, and Carlos Rocha-de-Lossada. "Visual Quality and Subjective Satisfaction in Ultrathin Descemet Stripping Automated Endothelial Keratoplasty (UT-DSAEK) versus Descemet Membrane Endothelial Keratoplasty (DMEK): A Fellow-Eye Comparison." Journal of Clinical Medicine 10, no. 3 (January 22, 2021): 419. http://dx.doi.org/10.3390/jcm10030419.

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Background: To analyze objective and subjective visual quality differences between descemet membrane endothelial keratoplasty (DMEK) and ultra-thin descemet stripping automated endothelial keratoplasty (UT-DSAEK) with a paired contralateral-eye design. Methods: A cross-sectional, comparative, and observational case series study between DMEK and UT-DSAEK were presented. Visual acuity, refractive status and corneal quality assessment were compared between both endothelial keratoplasty techniques. The sample consisted of 20 eyes (10 patients) diagnosed with Fuchs endothelial corneal dystrophy. All measurements were performed preoperatively and at six months after surgery. Analyzed data included the measurement of objective scattering index, modulation transfer function, Strehl ratio, and optical quality assessment (OQAS) values. Contrast sensitivity, subjective patient satisfaction, visual acuity, tomography, pachymetry, endothelial cell count, and refraction status were also analyzed. Results: Objective and subjective visual quality variables had similar results among UT-DSAEK and DMEK procedures. Statistically significant differences favoring DMEK against UT-DSAEK were found in endothelial cell density (658.80 ± 139.33 and 1059.00 ± 421.84 cells/mm2, respectively), pachymetry (621.20 ± 33.74 and 529.70 ± 30.00 µm, respectively), and follow-up (45.50 ± 24.76 and 15.50 ± 8.43 months, respectively). Conclusions: UT-DSAEK and DMEK revealed no differences in terms of objective and subjective visual quality. However, DMEK showed a faster recovery during the follow-up, increased endothelial cell density, lower pachymetry, and a more anatomical posterior keratometry against UT-DSAEK in this case series paired-eye study.
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5

Singh, Tanu, Parul Ichhpujani, Rohan Bir Singh, Sudesh Arya, and Suresh Kumar. "Is ultra-thin Descemet stripping automated endothelial keratoplasty a viable alternative to Descemet membrane endothelial keratoplasty? A systematic review and meta-analysis." Therapeutic Advances in Ophthalmology 15 (January 2023): 251584142211478. http://dx.doi.org/10.1177/25158414221147823.

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Background: Ultra-thin Descemet stripping automated endothelial keratoplasty (UT-DSAEK) is a recently developed surgical procedure that has shown promising results for the management of various corneal endothelial diseases. Objectives: To evaluate the outcomes of the UT-DSAEK to the Descemet membrane endothelial keratoplasty (DMEK). Design: A systematic analysis of the studies comparing UT-DSAEK with DMEK by evaluating one or more outcomes (vision, complications, and post-operative endothelial cell counts) was performed. The meta-analysis was done if two or more studies reported a common outcome. Methods: We used PubMed, EMBASE, and SCOPUS databases to identify articles comparing the outcomes of UT-DSAEK with DMEK and performed a meta-analysis using RevMan, version 5.4. Results: A total of six studies were included in this review (two randomized clinical trials and four non-randomized comparative studies). Our analysis showed the patients who underwent DMEK cases showed better visual outcomes with a mean difference of 0.06 LogMAR (95% CI: 0.04–0.09) in BCVA, albeit with i2 of 52% (heterogenous values). The evidence was weak, with the most weightage on retrospective studies. UT-DSAEK showed significantly fewer complications such as graft dislocations, with an odds ratio of 0.25 (95% CI: 0.13–0.48). There was no significant difference in the endothelial cell counts with a mean difference of 86.34 (95%CI: –133.09 to –305.77). Conclusion: Although the literature is limited on UT-DSAEK with post-operative visual acuity that could be practically at par with DMEK, lesser complication rates and comparable post-operative endothelial cells could be a suitable alternative to DMEK for corneal endothelial pathologies.
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6

Graffi, Shmuel, Pia Leon, Yoav Nahum, Shay Gutfreund, Rossella Spena, Leila Mattioli, and Massimo Busin. "Outcomes of ultrathin Descemet stripping automated endothelial keratoplasty (UT-DSAEK) performed in eyes with failure of primary Descemet membrane endothelial keratoplasty (DMEK)." British Journal of Ophthalmology 103, no. 5 (May 29, 2018): 599–603. http://dx.doi.org/10.1136/bjophthalmol-2017-311834.

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AimTo evaluate the outcomes of ultrathin Descemet stripping automated endothelial keratoplasty (UT-DSAEK) performed in eyes after failure of primary Descemet membrane endothelial keratoplasty (DMEK).MethodsThis was a retrospective, non-comparative interventional case series done in a tertiary care hospital. The study group included 21 eyes of patients which underwent UT-DSAEK following the failure of primary DMEK. Outcome measures included best spectacle-corrected visual acuity (BSCVA) and endothelial cell density (ECD) both recorded 6 and 12 months postoperatively as well as central graft thickness (CGT) measured 6 months after UT-DSAEK.ResultsWhen considering only eyes without comorbidities (17 of 21), 12 months after UT-DSAEK, BSCVA was ≥20/25 in 12/13 (92%) eyes and ≥20/20 in 4/13 (30%) eyes. Mean ECD loss rate was 38.9% at 12 months postoperatively (range 8%–57%). Six months postoperatively, CGT averaged at 81±34 µm (range 34–131 µm). No intraoperative complications were recorded. Postoperatively, one patient (no. 8) had graft wrinkles that were fixed 2 days following UT-DSAEK. Four patients have developed intraocular lens (IOL) opacification, and two of them underwent IOL exchange. No other postoperative complications were recorded.ConclusionsUT-DSAEK is instrumental in the management of primary DMEK graft failure, allowing visual rehabilitation which is comparable with that of repeat DMEK.
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7

Machalińska, Anna, Agnieszka Kuligowska, Bogna Kowalska, and Krzysztof Safranow. "Comparative Analysis of Corneal Parameters in Swept-Source Imaging between DMEK and UT-DSAEK Eyes." Journal of Clinical Medicine 10, no. 21 (October 30, 2021): 5119. http://dx.doi.org/10.3390/jcm10215119.

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Background: The need to provide a comparative analysis of corneal parameter changes compared to their preoperative values between Descemet membrane endothelial keratoplasty (DMEK) and ultrathin Descemet stripping automated endothelial keratoplasty (UT-DSAEK) patients. Methods: The study included 24 eyes after UT-DSAEK and 24 eyes after DMEK. Visual acuity, endothelial cell count (ECC), central corneal thickness (CCT), mean keratometry (MK), mean astigmatism (MA), astigmatism asymmetry (AA) and higher-order aberrations (HOAs) were assessed at baseline and 1, 3, 6 and 12 months after the surgery. Results: From the 3rd month post operation, ECC was higher in the DMEK eyes than in the UT-DSAEK eyes (p = 0.01). In a bivariate analysis that was adjusted for age, DMEK was associated with a smaller decrease in posterior MK at the 1-month (β = −0.49, p = 0.002), 3-month (β = −0.50, p < 0.001), 6-month (β = −0.58, p < 0.001) and 12-month (β = −0.49, p < 0.001) follow-up visits. There were no significant differences in changes in anterior or combined surface MK throughout the observation period. Accordingly, no significant differences in changes in MA, AA or HOAs compared to the baseline values were identified between the eyes after DMEK and UT-DSAEK at any follow-up time point. Conclusions: UT-DSAEK seemed to be an easier and safer technique than DMEK while maintaining similar outcomes regarding irregular astigmatism and total keratometry values.
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8

Schaub, Friederike, Philip Enders, Sigrid Roters, Claus Cursiefen, and Björn O. Bachmann. "Single-pass Ultrathin DSAEK (UT-DSAEK) with the SLc Expert Microkeratome®." Acta Ophthalmologica 95, no. 2 (August 29, 2016): e160-e161. http://dx.doi.org/10.1111/aos.13211.

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9

Bucher, F., S. Roters, A. Mellein, D. Hos, L. M. Heindl, C. Cursiefen, and M. Hermann. "“OSMO-UT-DSAEK” using THIN-C medium." Graefe's Archive for Clinical and Experimental Ophthalmology 251, no. 9 (August 2, 2013): 2181–85. http://dx.doi.org/10.1007/s00417-013-2434-0.

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10

Bachmann, B., F. Schaub, and C. Cursiefen. "Therapie von Hornhautendothelerkrankungen mittels DMEK und UT-DSAEK." Der Ophthalmologe 113, no. 3 (February 11, 2016): 196–203. http://dx.doi.org/10.1007/s00347-016-0221-0.

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11

Simons, Rob W. P., Mor M. Dickman, Frank J. H. M. Biggelaar, Carmen D. Dirksen, Jeroen Van Rooij, Lies Remeijer, Allegonda Van der Lelij, Robert H. J. Wijdh, Pieter J. Kruit, and Rudy M. M. A. Nuijts. "Trial‐based cost‐effectiveness analysis of ultrathin Descemet stripping automated endothelial keratoplasty (UT‐DSAEK) versus DSAEK." Acta Ophthalmologica 97, no. 8 (April 26, 2019): 756–63. http://dx.doi.org/10.1111/aos.14126.

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12

MURTA, J. "Femtosecond laser and microkeratome preparation of ultrathin (UT) DSAEK grafts." Acta Ophthalmologica 90 (August 6, 2012): 0. http://dx.doi.org/10.1111/j.1755-3768.2012.2723.x.

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13

Parekh, Mohit, Alessandro Ruzza, Davide Borroni, Stephen B. Kaye, and Vito Romano. "Artificial Anterior Chamber Pressure and Corneal Thinning Rate in UT-DSAEK." Cornea 37, no. 2 (February 2018): e5. http://dx.doi.org/10.1097/ico.0000000000001464.

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14

MURTA, J., A. ROSA, M. QUADRADO, S. BRITO, and A. CARDOSO. "Femtosecond laser and microkeratome preparation of ultrathin (UT) DSAEK Grafts, the six months clinical results." Acta Ophthalmologica 90 (August 6, 2012): 0. http://dx.doi.org/10.1111/j.1755-3768.2012.1631.x.

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15

Fasolo, Adriano, Antonella Franch, Cristina Monterosso, Davide Camposampiero, Anna Chiara Frigo, Marie-Claude Amoureux, Denis Fortier, and Diego Ponzin. "Results of ultrathin Descemet stripping automated endothelial keratoplasty with donor corneas preserved in synthetic organ culture media." European Journal of Ophthalmology, November 4, 2022, 112067212211331. http://dx.doi.org/10.1177/11206721221133141.

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Purpose To evaluate outcomes of ultrathin Descemet stripping automated endothelial keratoplasty (UT-DSAEK) with donor corneas preserved at 31°C in Cornea Syn®, a medium formulated with recombinant human serum albumin (rHSA) to replace foetal calf serum, and deswelled-transported in the xeno-free medium Cornea Trans®. Methods Prospective, multicentre, open-label study. We evaluated the endothelial cell loss (ECL) as the percentage variation of the endothelial cell density (ECD, cells/mm2) between 6 and 12 months after surgery, corneal transparency and thickness at 12 months, and adverse events within 12 months. Endothelial lenticules of mean 89 μm, ECD ≥ 2300 cells/mm2, minimum signs of cell mortality or morphology alterations, were dissected by microkeratome in the eye bank, and grafted in patients ≥ 18 years without corneal neovascularisation, conjunctivalization, or blinking impairment. Results Thirty-five patients underwent UT-DSAEK, 3 showed primary failure, 1 late failure, and 2 skipped the 6-month visit. We analysed data from 29 patients, 27 with Fuchs endothelial corneal dystrophy (FECD) and 2 with pseudophakic bullous keratopathy (PBK). The median ECL between 6 and 12 months was 2.6% ( p = .054, CI 0 to 12.5) and the absolute mean (SD) was 158.4 (364.1) cells/mm2. After 12 months, 96.5% of corneas were clear, with mean pachymetry of 585.9 (50.4) µm. Conclusions The ECL rate after UT-DSAEK match overall that observed in DSAEK or UT-DSAEK models of endothelial survival and the overall safety compared that reported for similar follow-up. Corneas maintained in Cornea Syn® and Cornea Trans® did not affect the ECD and functional outcomes of UT-DSAEK up to 12 months.
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16

Mimouni, Michael, Martin Kronschläger, Manuel Ruiss, and Oliver Findl. "Intraoperative optical coherence tomography guided corneal sweeping for removal of remnant Interface fluid during ultra-thin Descemet stripping automated endothelial keratoplasty." BMC Ophthalmology 21, no. 1 (April 15, 2021). http://dx.doi.org/10.1186/s12886-021-01934-2.

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Abstract Background Remnant interface fluid following Descemet stripping automated endothelial keratoplasty (DSAEK) is associated with postoperative detachments. The aim of this study was to assess outcomes of intraoperative optical coherence tomography (iOCT) guided meticulous peripheral corneal sweeping for removal of interface fluid during ultra-thin (UT) DSAEK. Methods This retrospective study included all eyes underwent iOCT guided UT-DSAEK from October 2016 to February 2018 at the Hanusch Hospital, Vienna, Austria. Peripheral meticulous corneal sweeping was performed to remove excess fluid. Central graft thickness (CGT) was measured prior to surgery, after graft bubbling and after corneal sweeping. Remnant interface fluid rates were compared between eyes that underwent rebubbling and those that did not. Results Overall, 28 eyes of 28 patients with a mean age of 73.9 ± 10.0 years were included. An iOCT guided meticulous peripheral sweeping was performed in 89.3% (n = 25) of the cases. Following 84% (n = 21) of the peripheral sweeping performed, remnant fluid was no longer identified. Following peripheral sweeping the interface fluid height was reduced from 17.31 ± 15.96 μm to 3.46 ± 9.52 μm (p < 0.001) and CGT was reduced by 7% (p < 0.001). Rebubbling was performed in 17.9% (n = 5) of the cases. The rebubbling group had a greater proportion of patients that had remnant fluid identified with iOCT at the end of surgery despite meticulous peripheral sweeping (60.0% versus 4.4%, p = 0.01). Conclusion The iOCT identified subclinical remnant fluid in nearly 90% of UT-DSAEK cases. An iOCT guided peripheral corneal sweeping led to resolution of interface fluid in a majority of cases. Eyes with persistent remnant fluid despite peripheral corneal sweeping are more likely to require subsequent rebubbling.
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Bodénès, F., Y. Eude, M. Baud’huin, B. Vabres, M. Weber, G. Le Meur, and I. Orignac. "Évaluation des greffes UT-DSAEK prédécoupées en banque multi-tissus." Journal Français d'Ophtalmologie, February 2023. http://dx.doi.org/10.1016/j.jfo.2022.08.012.

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18

Bielefeld, V., B. Vabres, M. Baud’huin, P. Lebranchu, G. Le Meur, and I. Orignac. "UT-DSAEK avec greffons préparés en banque, suivi de 79 greffes sur un an." Journal Français d'Ophtalmologie, December 2020. http://dx.doi.org/10.1016/j.jfo.2020.04.060.

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19

Simons, Rob W. P., Suryan L. Dunker, Mor M. Dickman, Rudy M. M. A. Nuijts, Frank J. H. M. van den Biggelaar, Carmen D. Dirksen, Robert P. L. Wisse, et al. "Trial‐based cost‐effectiveness analysis of Descemet membrane endothelial keratoplasty ( DMEK ) versus ultrathin Descemet stripping automated endothelial keratoplasty ( UT‐DSAEK )." Acta Ophthalmologica, October 31, 2022. http://dx.doi.org/10.1111/aos.15280.

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