Original article
Host and Graft Thickness after Descemet Stripping Endothelial Keratoplasty for Fuchs Endothelial Dystrophy

https://doi.org/10.1016/j.ajo.2010.05.011Get rights and content

Purpose

To determine relationships between vision, forward scatter, and total corneal and graft thicknesses after Descemet stripping endothelial keratoplasty (DSEK).

Design

Prospective, cohort study.

Methods

Forty-four eyes with Fuchs endothelial dystrophy were examined before and at 1, 3, 6, and 12 months after DSEK; all eyes were pseudophakic after surgery. Central total corneal and graft thicknesses were measured using confocal microscopy. Best-corrected high-contrast visual acuity (BCVA) was measured using the electronic Early Treatment Diabetic Retinopathy Study protocol, and forward light scatter was measured using a straylight meter.

Results

Total corneal thickness was 610 ± 50 μm (mean ± standard deviation) before DSEK, increased to 680 ± 74 μm by 1 month after DSEK (P < .001), and stabilized at 660 ± 68 μm by 3 months after DSEK (P = .03 vs 1 month). Graft thickness was 170 ± 57 μm at 1 month, decreased to 157 ± 49 μm by 3 months (P = .004), and then remained stable through 12 months (156 ± 51 μm; P = .99 vs 3 months). BCVA was 0.44 ± 0.21 logarithm of the minimal angle of resolution (logMAR) units (Snellen equivalent, 20/55) before DSEK, improved to 0.26 ± 0.20 logMAR units (Snellen equivalent, 20/36) by 3 months (P < .001), and improved to 0.16 ± 0.16 logMAR units (Snellen equivalent, 20/29) at 12 months (P < .001 vs 3 months). BCVA and forward light scatter did not correlate with corneal or graft thickness after DSEK.

Conclusions

Stromal edema resolves by 3 months after DSEK for Fuchs dystrophy, whereas visual acuity continues to improve through 12 months. Thicker corneas and grafts are not associated with worse visual acuity or increased forward scatter.

Section snippets

Subjects

Patients requiring DSEK because of decreased vision caused by Fuchs endothelial dystrophy were recruited from the cornea service at Mayo Clinic, Rochester, Minnesota. Subjects were excluded if they had a filtering bleb or uncontrolled glaucoma; central corneal scarring unrelated to Fuchs dystrophy, as determined by slit-lamp biomicroscopy; or a history of herpetic keratitis, maculopathy, or optic neuropathy. All eyes were either pseudophakic or had lenticular changes requiring cataract

Subjects

Forty-four eyes of 38 patients were enrolled in the study, of which 40 eyes (34 patients) were examined through 6 months. At 12 months, data were available only for 31 eyes (27 patients) because 2 patients (2 eyes) dropped out of the study, 1 patient (1 eye) died, 1 eye (1 patient) had graft failure, and 9 eyes (9 patients) had not reached the 12-month examination yet. Mean age ± standard deviation at the time of surgery was 67 ± 10 years (range, 41 to 87 years).

Corneal Thickness

Before surgery, total corneal

Discussion

DSEK has become the preferred method for treating endothelial dysfunction, and postoperative uncorrected visual acuity and refractive error are better than they are after penetrating keratoplasty.4, 14 In contrast to penetrating keratoplasty, in which the host cornea is replaced, DSEK is an additive procedure that results in an abnormally thick cornea. In this study, in which the minimum detectable predictive relationships (from r2) were 20% at 6 months and 25% at 12 months, we found no

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