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Esben Nielsen, Jesper Hjortdal; Visual Outcomes After Dsaek Surgery: Which Visual Quality Is Primarily Improved?. Invest. Ophthalmol. Vis. Sci. 2011;52(14):758.
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It has previously been reported that patients who suffer from Fuchs’ endothelial dystrophy have decreased contrast sensibility threshold. The removal of endothelial guttata by DSAEK surgery has also been demonstrated to decrease intraocular light scatter and improve contrast thresholds. The purpose of this study was to compare different visual qualities in patients that had undergone DSAEK surgery in one eye while having untreated Fuchs’ dystrophy in the other eye.
32 eyes of 16 patients with bilateral Fuchs’ endothelial dystrophy who had DSAEK surgery performed in one eye were enrolled. Visual acuity at 100% contrast and contrast sensitivity as evaluated by a modified simulation of the Freiburg Acuity and Contrast Test, FrACT, was measured in both eyes of each patient.
Snellen visual acuity improved in treated eyes from 0.67 ± 0.35 (SD) before surgery to 0.42 ± 0.21 after surgery (logMAR units; P=0.038). In eyes with untreated Fuchs’ dystrophy visual acuity was 0.48 ±0.13. In a pair-wise comparison, there was no difference in Snellen visual acuity between treated and non-treated eyes (P=0.39). Contrast sensitivity was significantly better in DSAEK treated eyes compared with untreated eyes. Mean logCS in DSAEK treated eyes was 1.06 ± 0.26 compared with a mean logCS of 0.85 ± 0.15 in untreated eyes (P=0,016). All patients reported a subjective improvement in vision from before to after DSAEK surgery.
In this study of patients with Fuchs’ dystrophy treated in one eye with DSAEK surgery, we demonstrated improved contrast sensitivity in the DSAEK operated eyes while no difference in visual outcome was detected with standard Snellen visual acuity. This is an interesting finding, since it implies that subjective visual improvements caused by mainly an improved ability to discern contrast can be undetectable with standard Snellen BSCVA.
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