Comparative clinical outcomes of femtosecond laser-assisted versus manual Descemet membrane endothelial keratoplasty for corneal endothelial dysfunction: A systematic review and meta-analysis

PURPOSE: To compare the clinical efficacy and safety of femtosecond laser-assisted Descemet membrane endothelial keratoplasty (F-DMEK) and manual Descemet membrane endothelial keratoplasty (M-DMEK) for the treatment of corneal endothelial dysfunction. METHODS: Comparative studies with a minimum follow-up of 3 months were included in this meta-analysis. Pooled data were collected using a random effect model with Newcastle–Ottawa Scale tool-based risk assessment and Grading of Recommendation Assessment, Development, and Evaluation (GRADE) used for results certainty assessment. Results were reported as odds ratio (OR) or mean difference with 95% confidence intervals (CI). Heterogeneity and publication bias were tested using I 2 and Egger’s test. RESULTS: Four small and nonrandomized comparative studies with a total of 225 eyes (54 F-DMEK, 171 M-DMEK) met the inclusion criteria in 51 identified articles. F-DMEK demonstrated lower odds of graft detachment (OR: 0.12; 95% CI: 0.04 to 0.39) and rebubbling rate (OR: 0.14; 95% CI: 0.04 to 0.44) compared to the M-DMEK group. No significant differences were found in primary graft failure, graft rejection, or best-corrected visual acuity at 3–12 or 6 months. The low heterogeneity and sensitivity analysis results confirmed the robustness of these findings. GRADE assessment showed very low-to-moderate certainty of evidence. CONCLUSION: F-DMEK showed advantages in reducing graft detachment and rebubbling rates compared with M-DMEK. However, these findings should be interpreted with caution due to the very low-to-moderate certainty of evidence and the reliance on the small, nonrandomized studies.