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Letter
Radial graft contraction may relate to subnormal visual acuity in Descemet stripping (automated) endothelial keratoplasty
  1. Kyros Moutsouris1,2,
  2. Lisanne Ham1,2,
  3. Isabel Dapena1,2,
  4. Jacqueline van der Wees1,3,
  5. Gerrit R J Melles1,2,3
  1. 1Netherlands Institute for Innovative Ocular Surgery, Rotterdam, The Netherlands
  2. 2Melles Cornea Clinic Rotterdam, The Netherlands
  3. 3Amnitrans EyeBank Rotterdam, The Netherlands
  1. Correspondence to Dr Gerrit R J Melles, Netherlands Institute for Innovative Ocular Surgery, Rotterdam 3071 AA, The Netherlands; melles{at}niios.com

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Since 1998, we have introduced various concepts for endothelial keratoplasty, popularised as ‘deep lamellar endothelial keratoplasty’ (DLEK), ‘Descemet stripping (automated) endothelial keratoplasty’ (DSEK/DSAEK) and ‘Descemet membrane endothelial keratoplasty’ (DMEK).1 Large clinical studies on DSEK/DSAEK reported a best-corrected visual acuity (BCVA) averaging 20/40 (0.5) at 6 months after surgery, with only few cases reaching ≥20/25 (≥0.8).2 3 In a first series of DMEK surgeries for Fuchs endothelial dystrophy, a majority of cases reached ≥20/25 (≥0.8).4 Apparently, a cornea may obtain a better optical performance after transplantation of an isolated donor Descemet membrane and its endothelium in DMEK, than with a thicker graft also containing donor posterior stroma as used in DSEK/DSAEK.1 If so, compromised optical quality of the transplanted cornea may relate to the presence of donor stroma in DSEK grafts. In this letter, we describe a potential mechanism of how donor posterior stroma may limit final BCVA in endothelial keratoplasty, by progressive graft contraction.

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