Surgeon Perspectives on Descemetorhexis Without Endothelial Keratoplasty for Fuchs Endothelial Corneal Dystrophy: A UK National Survey

Introduction: To provide an insight into the current perspective of UK ophthalmic surgeons on the role of Descemetorhexis without endothelial keratoplasty (DWEK) for the management of Fuchs endothelial corneal dystrophy (FECD).

Materials and methods: A Google Form (Google, UK) was electronically distributed to UK ophthalmologists with a special interest in cornea from November 2023 to June 2024. The survey consisted of 13 mandatory questions.

Results: Responses were received from 36 ophthalmic surgeons from across the UK, with clinical experience ranging from 0.5 to 30 years. Descemet membrane endothelial keratoplasty (DMEK) and Descemet stripping (automated) endothelial keratoplasty (DSEK/DSAEK) were the most common approaches for managing FECD. Only four respondents had practiced DWEK, but 97.2% expressed interest in learning this technique (35/36). Additionally, 69.4% felt that DWEK would be beneficial only with RHO kinase inhibitors (25/36). All respondents agreed that the clinical field would benefit from randomised trials comparing DWEK to DMEK/DSAEK, and 97.2% were open to changing their clinical practice based on the findings of such trials (35/36).

Discussion: This article provides the first snapshot of UK ophthalmic surgeons' views on DWEK in FECD. DWEK has potential as a surgical technique in selective cases, particularly with RHO kinase inhibitors. Optimal visual outcomes with DWEK depend on careful patient selection, necessitating an evidence-based approach to define patient selection criteria. Future studies should compare visual and complication outcomes between DWEK and DMEK/DSAEK in clinical trials, incorporating RHO kinase inhibitors.