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David A. Lewis, Dorrie M. Happ, Aneesh Neekhra, Kevin H. Eng, Heather A. Potter, Christopher R. Croasdale, David R. Hardten, Sarah Nehls, Daniel M. Albert; Lamination Of Descemet’S Membrane Without Embedded Guttae In Fuchs’ Endothelial Dystrophy Patients Is Associated With Worse Visual Outcome Following Dsek. Invest. Ophthalmol. Vis. Sci. 2011;52(14):753.
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To investigate a correlation between the severity of histologic changes of Descemet’s membrane in patients with Fuchs’ endothelial dystrophy and the postoperative best-corrected visual acuity following Descemet’s membrane stripping endothelial keratoplasty (DSEK). Best-corrected postoperative visual acuity may be limited by progressive, irreversible corneal stromal changes that are related to histologic changes in Descemet’s membrane.
In a retrospective study design, a histologic grading system was created based on common characteristics observed histologically among 92 DSEK specimens sent to the UW Eye Pathology Laboratory with a clinical diagnosis of Fuchs’ dystrophy from three separate corneal surgeons. Cases were graded as mild, moderate, or severe based on four characteristics including guttae dispersion, presence of a laminated Descemet’s membrane, presence of embedded guttae, and density of guttae. A regression analysis was performed to study the correlation between histologic findings and best corrected visual acuity six months after DSEK surgery.
No correlation was found between the severity of histologic changes of Descemet’s membrane and preoperative visual acuity. A correlation exists, however, between the preoperative visual acuity and the postoperative visual acuity. Cases with a laminated Descemet’s membrane but no embedded guttae (n=8) appear less responsive to DSEK surgery. Otherwise the severity of histologic changes of Descemet’s membrane observed in patients with Fuchs’ corneal dystrophy and the best-corrected postoperative levels of visual acuity ≤ 20/40 following DSEK did not show a statistically significant correlation with final visual acuity .
Patients who develop a laminated Descemet’s membrane without embedded guttata may benefit from earlier surgery. Otherwise our analysis fails to demonstrates an inverse relationship between the severity of histologic changes of Descemet’s membrane and the best-corrected postoperative levels of visual acuity ≤ 20/40 following DSEK.
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