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Jan D. Unterlauft, Katharina Weller, Gerd Geerling; Changes Of Corneal Geometry After DSEK And DSAEK. Invest. Ophthalmol. Vis. Sci. 2011;52(14):771.
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Posterior lamellar keratoplasty can be carried out using manually (Descemet Stripping Endothelial Keratoplasty: DSEK) and automatically dissected lamellar transplants (Descemet Stripping Automated Endothelial Keratoplasty: DSAEK). The impact of both methods on visual acuity, refraction and corneal geometry during the first postoperative months was analyzed.
DSEK was performed in 19 and DSAEK in 18 eyes. One and six weeks and three and six months after surgery best corrected visual acuity (BCVA), objective refraction (OR) and corneal geometry were assessed using Scheimpflug-photography (Pentacam) and anterior segment OCT (AS-OCT).
In the 19 DSEK eyes (mean age: 71.8±10.2 years, 5 male, 14 female) BCVA improved from 1.1±0.5 to 0.4±0.2 logMAR. In the 18 DSAEK eyes (mean age: 74.8±8.6 years, 4 male 14 female) BCVA improved from 1.0±0.5 to 0.3±0.2 logMAR during 6 months of follow-up. Pentacam results revealed a change of mean corneal refractive power towards hyperopia from 37.1±1.4 to 36.0±1.1D in the DSEK-group and from 37.6±1.6 to 36.4±1.4D in the DSAEK-group. Anterior corneal curvature did not change significantly (DSEK: p=0.7; DSAEK: p=0.4). Posterior corneal curvature changed significantly in the DSEK-group (p=0.006) and in the DSAEK-group (p=0.002). The change of posterior corneal curvature was not statistically different in between groups (p=0.114). The hyperopic shift was also found in the OR results with a mean change of 0.67±1.27D and 0.71±1.34D in the DSEK/DSAEK-groups. Central corneal thickness decreased from 758±107 to 589±68µm in the DSEK-group and from 705±93 to 652±124µm in the DSAEK-group. AS-OCT examinations revealed a decrease of mean central transplant thickness from 246±71µm to 160±53µm and from 186±46µm to 114±43µm while the mean thickness at the transplants peripheral edges decreased from 430±128µm to 301±168µm and from 365±155 to 264±82µm in the DSEK and DSAEK-groups during the first 6 months of follow-up.
DSEK and DSAEK lead to satisfactory visual rehabilitation while inducing a distinct change of corneal geometry leading to a hyperopic shift of varying amount.
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