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Eleanor Trousdale, David Hodge, Keith H Baratz, Leo J Maguire, William M Bourne, Sanjay V Patel; Quality of Life Before and After Keratoplasty for Fuchs Endothelial Dystrophy. Invest. Ophthalmol. Vis. Sci. 2014;55(13):2703.
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To assess health-related quality of life (HR-QOL) in Fuchs endothelial corneal dystrophy (FECD), and changes in HR-QOL after three types of keratoplasty (penetrating keratoplasty, PK; deep lamellar endothelial keratoplasty, DLEK; and Descemet stripping endothelial keratoplasty, DSEK) for FECD.
Patients with corneal edema due to FECD were enrolled in two consecutive prospective studies at Mayo Clinic, Rochester, MN. In a randomized controlled trial, 12 eyes (12 patients) received PK and 11 eyes (11 patients) received DLEK. In a prospective observational study, 40 eyes (40 patients) received DSEK. All subjects were examined before keratoplasty and at 6 months, 1 year, and 3 years after keratoplasty. At each examination, HR-QOL was assessed by using the 25-item National Eye Institute Visual Functioning Questionnaire; best-spectacle-corrected and uncorrected visual acuities were measured by using the electronic Early Treatment of Diabetic Retinopathy Study protocol; and disability glare was measured with a straylight meter (C-Quant, Oculus, Inc.).
The mean HR-QOL composite score for all eyes with FECD before keratoplasty was 72 ± 11 (n=63). HR-QOL improved by 6 months with all treatments when compared to preoperative (PK, p=0.008; DLEK, p=0.03; DSEK, p<0.001). At 6 months, HR-QOL was higher after DSEK than after PK (p=0.006), whereas at 3 years, there were no significant differences in HR-QOL between PK, DLEK, and DSEK (p=0.33; mean minimum detectable difference, 8 [α=0.05, β=0.20]). After keratoplasty, HR-QOL was correlated with uncorrected visual acuity at 1 year (r= -0.38, p=0.001) and at 3 years (r= -0.36, p=0.02), with disability glare at 3 years (r= -0.41, p=0.02), and with best-corrected visual acuity at 6 months (r= -0.34, p=0.03), but not thereafter.
HR-QOL is impaired in patients with FECD (compared to subjects with healthy eyes who typically have composite scores >90), but improves after keratoplasty, irrespective of the technique. The improvement in HR-QOL is faster after DSEK compared to after PK, and might be explained in part by rapid improvement in uncorrected visual acuity after DSEK.
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