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Sanjay V. Patel, Ivanka J. van der Meulen, Thomas J. van den Berg, Jay W. McLaren; Quality of Vision in Fuchs Endothelial Dystrophy Before and After Descemet-Stripping Endothelial Keratoplasty. Invest. Ophthalmol. Vis. Sci. 2011;52(14):1631.
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© ARVO (1962-2015); The Authors (2016-present)
To determine quality of vision (visual acuity and straylight) in eyes with Fuchs endothelial dystrophy and factors affecting quality of vision after Descemet-stripping endothelial keratoplasty (DSEK).
Forty-eight eyes (41 patients, ages 41 to 87 years) with Fuchs dystrophy requiring DSEK were recruited at Mayo Clinic, Rochester, MN, and 94 eyes (66 patients, ages 40 to 91 years) with varying grades of Fuchs dystrophy were recruited at the Academic Medical Center, Amsterdam, Netherlands. In all eyes, best-corrected visual acuity (BCVA) was measured by using the ETDRS protocol, and straylight (disability glare) was measured by using a straylight meter (C-Quant, Oculus). In the Mayo group, corneal subepithelial haze (backscatter) was measured by using confocal microscopy (ConfoScan 4, Nidek). All variables were also measured in 37 eyes in the Mayo group at 12 months after DSEK (all eyes were pseudophakic postoperatively). Correlations between visual acuity, straylight, subepithelial backscatter, and age, were assessed before and after DSEK, and significances were determined by using generalized estimating equation models.
In all eyes with Fuchs dystrophy, BCVA was 0.42 ± 0.26 logMAR (mean ± SD) and correlated with age (r= 0.31, p<0.001, n= 142); straylight was 1.54 ± 0.24 log straylight parameter (log(s)) and was not correlated with age (r= -0.04, p=0.67, n=140), in contrast to a known increase in straylight with age in normal eyes. At 12 months after DSEK, straylight was 1.35 ± 0.20 log(s); the improvement in straylight between preoperative and 12 months was correlated with recipient age (r= -0.43, p= 0.01, n=33), and preoperative straylight >1.30 log(s) was associated with postoperative improvement. In patients less than 63 years old with minimal, if any, cataract preoperatively, the improvement in straylight after DSEK correlated with the improvement in corneal subepithelial haze (r= 0.53, p= 0.005, n=15).
Younger patients with Fuchs dystrophy are affected more by increased straylight than by loss of high-contrast visual acuity. Straylight improves more in younger eyes than it does in older eyes after DSEK, and can be a useful preoperative metric to help determine the timing of surgical intervention, especially when visual acuity is minimally decreased. Improvement in subepithelial haze might be one explanation for improvement in straylight after DSEK.
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