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Srini Goverdhan, Aris Konstantopoulos, Ahmad Elshan, David Anderson, Parwez Hossain; Effect of Posterior Donor Lenticule Thickness on Optical Abberations and Visual outcome with time after Descemet Stripping Endothelial Keratoplasty (DSEK). Invest. Ophthalmol. Vis. Sci. 2011;52(14):783.
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To evaluate optical and visual outcomes of DSEK as a function of time.
Fifty-one eyes from 50 consecutive patients who underwent DSEK for Fuchs’ endothelial dystrophy and pseudophakic bullous keratopathy and had been followed up for > 12 months (mean=12.43 months) were identified retrospectively. All donor lenticules were prepared manually. Pre and post surgical data analysed included best corrected LogMAR acuity, manifest refraction, central corneal thickness, endothelial graft thickness (Zeiss Visante AS-OCT), corneal wavefront ocular aberrometry (root mean square values for higher order, lower order and total astigmatism in the central 4mm, 5mm and 6mm areas using Zeiss-Atlas Omni corneal topography) and total aberration using Shack-Hartman wavefront analysis (AMO-VisX Wavescan). Statistical analysis was performed using SPSS v17.
Mean age of our cohort was 73.4 years (n=50). Mean spherical and cylindrical error did not change significantly post DSEK (0.77 ± 1.44 DS and -1.75 ± 1.81 DC versus 1.06 ± 2.7 DS and -1.80 ± 2.5 DC pre DSEK). Visual acuity improved from a mean of 0.97 ± 0.54 logMAR to 0.66 ± 0.55 logMAR (P<0.0001). Post DSEK root mean square values for total aberrations ranged from 1.22 µm to 2.68 µm, while values for higher order abberations ranged from 0.61 µm to 1.73 µm (n=19). Corneal thickness reduced from a mean of 637 µ to 525 µ (P<0.0001). Median donor lenticule thickness was 269 µ at month 1, 247 µ at month 3, 232 µ at month 6 and 143 µ at last follow up (range = 52µ to 290µ) with an average diameter of 9.04 ± 0.41 mm. No statistical correlation could be found between donor lenticule thickness and ocular abberations or between lenticule thickness and visual outcomes.
This is the first study to examine posterior lenticule thickness using AS-OCT and explore the relationship with corneal HOA and refractive and visual outcomes over time. DSEK donor lenticular thickness varied significantly with time. Correlation with refractive metrics including corneal aberration, total HOA and refractive status are discussed. Defocus and astigmatism did not change significantly one year post DSEK compared with pre-operative values whilst visual acuity improved significantly. Lenticule thickness measured by AS-OCT after one year in-situ did not correlate with optical aberration, refractive or visual outcome.
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