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D. Srikumaran, J. Doyle, W. J. Stark, A. S. Jun; Relationship Between Visual Acuity Outcomes and Corneal Parameters After Descemet Stripping Endothelial Keratoplasty. Invest. Ophthalmol. Vis. Sci. 2009;50(13):619.
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To assess a relationship between visual acuity outcomes and various corneal parameters after Descemet Stripping Endothelial Keratoplasty (DSEK).
Retrospective review of patients that underwent primary DSEK with greater than 3 months of follow up at the Wilmer Eye Institute. Eyes with other vision-limiting ocular comorbidities or history of other corneal surgery were excluded. Post-operative best-spectacle corrected visual acuity (BSCVA), ultrasonic pachymetry, and a Pentacam scan (Oculus) were performed for each eye (N=13). The surface reflectivity and interface reflectivity were measured from the Pentacam and used as surrogates for corneal haze. The donor graft thickness was also measured from the Pentacam.The patients were divided into 2 groups: group 1 with BSCVA 20/40 or worse (N=5) and group 2 with BSCVA 20/30 or better (N=8). The mean and standard deviation of each parameter were calculated for each group and then compared to determine statistical significance.
Patients in group 1 had higher mean surface (39 ± 7 vs 36 ± 9) and interface (20 ± 3 vs 19 ± 3) reflectivity compared to group 2. The mean ultrasonic post-operative pachymetry in micrometers was also higher in group 1 (670 ± 54) compared to group 2 (621 ± 43). The mean graft thickness in micrometers as measured on the Pentacam was significantly higher in group 1 (214 ± 42) compared to group 2 (156 ± 33) with a p-value of 0.02.
Eyes with better BSCVA after DSEK tend to have thinner overall pachymetry and as well as thinner donor grafts. Surgical modifications to reduce donor graft thickness may improve visual outcomes in the future. Eyes with worse BSCVA after DSEK tend to have higher surface and interface reflectivity which may be representative of interface haze and subepithelial haze from prior chronic corneal edema. Additional studies are needed to assess the potential relative impact of corneal haze and donor graft thickness on visual acuity outcomes after DSEK.
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