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Maria A. Woodward, Shahzad Mian, Roni M. Shtein; Visual Acuity and Lamellar Thickness in Descemet’s Stripping Automated Endothelial Keratoplasty (DSAEK). Invest. Ophthalmol. Vis. Sci. 2012;53(14):3134.
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To assess the relationship between DSAEK graft thickness and visual acuity. It has been suggested that thinner grafts are associated with improved visual acuity; however, only preoperative lamellar thickness (LT) is known prior to surgery.
Patients who underwent DSAEK surgery from 2006-08 and had postoperative imaging with AS-OCT were included in this retrospective study. Patients were excluded for graft rejection, failure, or ocular co-morbidities. We compared preoperative LT and postoperative LT with best corrected visual acuity (BCVA) using paired t-tests and Pearson correlation coefficients.
Sixty eyes were evaluated for a mean of 27 months (range: 4-52 months). The preoperative LT of 196 ± 43 µm (range 106-287, by eye bank pachymetry) was higher than the postoperative LT of 167 ± 54 µm (range 88-335, by OCT imaging)(p<0.0001). Mean logMAR BCVA was 0.18 at 1 yr and 0.17 at the last follow-up (range 0.0-0.7 and 0.0-1.0, respectively). There was a strong correlation of BCVA at 1 year with BCVA at the last visit (R=0.85, p<0.0001). There was a poor correlation of BCVA at last visit with pre-LT (R=0.14, p=.44) or with post-LT (R=0.23, p=.22). The average preoperative endothelial cell density was 2811 ± 289 cell/mm2 (range: 2277-3649). By linear regression analysis, there was no association of either post-LT or BCVA at last visit with endothelial cell density, patient age, death-processing, death-to-surgery, donor age, or length of follow-up.
Lamellar thickness significantly decreases after surgery. Neither preoperative nor postoperative lamellar thickness correlated with best corrected visual acuity in this patient cohort.
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