Eye bank pre-stripped versus surgeon-stripped graft for Descemet membrane endothelial keratoplasty: a systematic review and meta-analysis.

Abstract

To summarize the evidence examining the outcomes of Descemet membrane endothelial keratoplasty (DMEK) using eye bank pre-stripped versus surgeon prepared grafts. Systematic review and meta-analysis. This study was conducted following the preferred reporting items for systematic reviews and meta-analyses consensus statement (PROSPERO ID: CRD42023457120). Searches of medline (Ovid), EMBASE, EMCARE, the Cochrane register of controlled trials, and grey literature were performed until April 2025. All comparative studies comparing DMEK outcomes after eye bank prepared (pre-stripped only) with surgeon-prepared tissue were included. Two independent reviewers completed data extraction and performed quality assessments. The primary outcomes were the rebubbling rate and corrected distance visual acuity (CDVA). Results were summarized using a random-effects meta-analysis. Five studies totalling 750 eyes receiving DMEK grafts were included. Four were retrospective observational studies and one was a non-randomized prospective study. There were no significant differences between eye bank pre-stripped and surgeon-prepared graft outcomes with regards to rebubbling rate (odds ratio, 1.11; 95% confidence interval [CI] 0.65 to 1.90) and postoperative logMAR CDVA (mean difference - 0.11, 95% CI - 0.23 to 0.01). No statistically significant difference was noted in postoperative corneal thickness, endothelial cell loss or density, and postoperative complications.Eye bank pre-stripped grafts and surgeon-prepared grafts yield comparable outcomes in terms of CDVA and rebubbling rates following DMEK.However, there is limited evidence, as only five studies were included in this analysis.