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Original article
Impact of graft thickness on visual acuity after Descemet's stripping endothelial keratoplasty
  1. Anthony J Shinton1,
  2. Michael Tsatsos2,
  3. Aris Konstantopoulos2,
  4. Srini Goverdhan2,
  5. Ahmad F Elsahn2,
  6. David F Anderson2,
  7. Parwez Hossain1,2
  1. 1Division of Infection, Inflammation and Immunity, Faculty of Medicine, University of Southampton, Southampton, UK
  2. 2Southampton Eye Unit, Southampton General Hospital, Southampton, UK
  1. Correspondence to Parwez Hossain, University of Southampton, Eye Unit, MP104, Southampton General Hospital, Tremona Road, Southampton SO16 6YD, UK; parwez{at}


Objective To evaluate the relationship, over time, between central graft thickness and visual acuity following Descemet's stripping endothelial keratoplasty (DSEK).

Methods A retrospective analysis of 70 consecutive cases of DSEK. All donor lenticules were dissected manually. Serial postoperative measurements of central graft and total corneal thicknesses were made using anterior segment optical coherence tomography. Visual acuity, refraction and patient demographics were collected from case notes. The correlation between central graft thickness and visual acuity at serial time points was calculated.

Results The median age at surgery was 75 years (lower quartile (LQ) 66, upper quartile (UQ) 83, range 36–90 years). Nineteen eyes were excluded from statistical analysis, leaving 51 eyes of 46 patients remaining. Last follow-up occurred a median of 12 months postoperatively (LQ 6, UQ 23, range 4–38 months). The median preoperative visual acuity was 0.71 logarithm of the minimum angle of resolution (logMAR), improving to 0.34 logMAR postoperatively (p<0.001, n=43). Median graft thickness decreased from 209 μm at day 1 to 142 μm at last follow-up (p<0.001). No statistically significant correlation was found between central total corneal thickness and visual acuity at any time point. Except for a single time point, no statistically significant correlation was found between central graft thickness and visual acuity.

Conclusion There is no clear association between central graft, or total corneal, thickness and visual acuity following DSEK.

  • Anatomy
  • cornea
  • corneal transplantation
  • Descemet stripping endothelial keratoplasty
  • Fuchs' endothelial dystrophy
  • immunology
  • infection
  • microbiology
  • ocular surface
  • optical coherence tomography
  • sclera and episclera
  • stem cells

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  • Competing interests None.

  • Ethics approval Ethics committee approval was obtained from Southampton and South West Hampshire Local Research Ethics Committee. The study adhered to the tenets of the Declaration of Helsinki.

  • Provenance and peer review Not commissioned; externally peer reviewed.