Beyond keratoplasty: The role of Descemet stripping only in the management of Fuchs endothelial dystrophy-a systematic review and meta-analysis.
Gozde Sahin Vural, Zeynep Akgun, Ozlem Barut Selver
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In 30 seconds
This systematic review and meta-analysis assessed Descemet stripping only (DSO) for Fuchs endothelial corneal dystrophy (FECD), including prospective and retrospective clinical series with at least 5 patients and 6 months of follow-up. Fifteen studies were included. The pooled corneal clearance rate was 0.91 (95% CI, 0.85-0.96), while 10% of patients required secondary endothelial keratoplasty (95% CI, 0.05-0.15). Clearance was higher with prophylactic ROCK-inhibitor use than without it (96% vs. 85%; p = 0.0012). The authors describe DSO as a potential alternative to endothelial keratoplasty for selected patients, while noting variation in outcomes.
Key findings
- Pooled corneal clearance after DSO was 0.91 (95% CI, 0.85-0.96).
- Prophylactic ROCK-inhibitor use was associated with higher clearance than no use (96% vs. 85%; p = 0.0012).
- Secondary endothelial keratoplasty, treated as surgical failure, was required in 10% (95% CI, 0.05-0.15).
- The pooled mean difference in BCVA was 0.23 LogMAR (95% Confidence Interval [CI] -0.30 to -0.17).
Why it matters
DSO may offer an alternative to endothelial keratoplasty for some patients with FECD, potentially reducing reliance on donor tissue and avoiding risks and complexity associated with transplantation. The pooled clearance and reoperation estimates help frame its potential benefits and likelihood of subsequent surgery, while the variation across studies highlights that outcomes depend on patient selection and complementary therapies.
What to keep in mind
The evidence came from 15 prospective or retrospective clinical series rather than randomized trials, and the review reports variation in outcomes and patient selection. The authors call for prospective studies to establish standard indications.