Background/aims To determine whether the stromal rim that carries the bare endothelial graft in Descemet's membrane automated endothelial keratoplasty (DMAEK) has any effect on final visual outcome or visual quality.

Methods Twenty-four DMAEK eyes and 22 Descemet's membrane endothelial keratoplasty (DMEK) eyes (with no stromal rim) were evaluated for corrected distance acuity, full-field Humphrey visual field (VF) 120-2 and pupil size. The inner and outer diameter of the DMAEK stromal ring was measured from slit lamp photos. Patients completed a questionnaire rating postoperative symptoms and visual complaints. Exclusion criteria were pre-existing glaucoma, retinal pathology or inability to return for postoperative examinations.

Results Median Snellen acuities were comparable between DMAEK and DMEK groups: 20/25 and 20/20-3, respectively. The mean central opening of the DMAEK stromal ring was 5.6×5.5 (range 3.8–6.9) mm. The incidence of VF defects, visual complaints of glare, halos, light sensitivity and night driving difficulties was comparable between groups (all p>0.1). A larger scotopic pupil size (<5.5 mm) was not associated with increased incidence of VF defects in either group (p=0.3).

Conclusions Surprisingly, compared with uniformly thin DMEK grafts, DMAEK grafts with a stromal rim had no increase in VF defects or visual complaints.