In the alphabet soup of corneal transplant options, which surgery is best? At the time of the DETECT trial, Descemet Stripping Automated Endothelial Keratoplasty (DSAEK) was the more common surgery used for endothelial keratoplasty, owing to the newness and lack of clear evidence of superior outcomes for Descemet Membrane Endothelial Keratoplasty (DMEK). The DETECT trial sought to provide level 1 evidence to support the expanded use of DMEK. They randomized 50 eyes to DMEK/DSAEK (25 each) to undergo these surgeries by 2 well-trained surgeons at 2 institutions, and sought to assess visual and surgical outcomes.
Key Points:
- DMEK led to improved BSCVA at 3, 6, 12 months (1.5 lines, 1.8 lines, 1.4 lines, respectively), all with statistically significant levels of improvement
- There was a non-statistically significant increase endothelial cell loss with DMEK compared to DSAEK (215 fewer cells/mm2at 12 months, P = 0.051)
- There was no statistically significant increase in adverse events, though the study may have been underpowered to assess for such differences
Overall, the DETECT study provided much needed evidence to support increased use of DMEK as a superior form of endothelial keratoplasty (EK). Before the DETECT trial, DMEKs accounted for less than 15% of EKs, and by the end of 2021, the number of DMEKs and DSAEKs completed in the US were approximately equal.
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