Two year visual acuity and contrast sensitivity outcome following Descemet’s Stripping Automated endothelial keratoplasty (DSAEK) and the correlation with preoperative donor graft thickness

Abstract

Purpose: To evaluate the long-term improvement of visual acuity and contrast sensitivity after Descemet’s Stripping automated endothelial keratoplasty (DSAEK) surgery over 2 years in patients with Fuch’s Endothelial Dystrophy (FED) and Pseudophakic Bullous Keratopathy (PBK) and the correlation with preoperative donor graft thickness.

Methods: Retrospective analysis of a noncomparative, interventional case series. We conducted a retrospective study of 77 consecutive patients (80 eyes) who underwent DSAEK in Singapore National Eye Centre for which the surgical indication was either FED or PBK in 2006- 2009 and completed a 2 year follow-up period. Our main outcome measures were best spectacle corrected post-operative visual acuity and contrast sensitivity.

Results: Best spectacle corrected visual acuity (BSCVA) improved over the first year post DSAEK in both Pseudophakic bullous keratopathy (PBK) and Fuch’s endothelial dystrophy (FED) patients and remained stable subsequently. However, we found that contrast sensitivity improved more drastically over the first 6 months post DSAEK in patients with FED and remained stable after 6 months, whilst in patients with PBK, the contrast sensitivity progressively improved over post operative first year and remained stable thereafter. There was a fair correlation of post-operative contrast sensitivity with BSCVA from baseline to 12 months after surgery for spatial frequencies of 3.0, 6.0 and 12.0 cpd. Our study found no correlation between pre-operative graft thickness and post-operative visual outcome for donor graft thickness from 100µm- 300µm.

Conclusions: Greater improvement in contrast sensitivity is noted in patients with FED compared to PBK at 6 months post DSAEK. However, there was no difference in eventual contrast sensitivity between the 2 groups 2 years post DSAEK.

Keywords: 481 cornea: endothelium • 478 contrast sensitivity • 479 cornea: clinical science