Our study seeks to establish whether Descemetorhexis without endothelial keratoplasty (DWEK) and the EndoArt® implant can serve as alternatives or replacements for endothelial keratoplasty (EK) in treating corneal endothelial dysfunction. A systematic review and meta-analysis were conducted separately for both interventions. PubMed, Cochrane Library, Ovid Medline, Science Direct, and ClinicalTrials.gov were searched until July 2025. The primary outcome was defined as interventional success or failure (indicated by the subsequent need for conversion to EK). Secondary outcomes comprised changes in visual acuity (VA), central corneal thickness (CCT), peripheral endothelial cell density (ECD), and postoperative central ECD. We included nineteen studies on DWEK and eight on EndoArt®. DWEK and EndoArt® proved their overall safety through achieving high success rates. Both procedures led to improvements in VA and CCT. DWEK analysis of ECD patterns showed a downward trend in peripheral ECD, along with a simultaneous upward trend in central ECD. Therefore, DWEK and EndoArt® emerged as promising therapeutic options for corneal endothelial dysfunction. DWEK could serve as an alternative for early-stage pathologies confined to the central endothelium without peripheral involvement. EndoArt®'s application remains limited to more extensive dysfunction that involves the periphery, especially after EK has already failed. Yet, the original question, of whether acellular treatment options could potentially replace EK, remains unanswered, and should be the endeavour of future multi-center randomized clinical trials.
Γεώργιος Χ. Γιαννακόπουλος (Wed,) studied this question.