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H. A. Potter, D. M. Happ, R. J. Peralta, A. Neekhra, S. M. Nehls, D. M. Albert, C. Croasdale, D. R. Hardten; Post-Operative DSEK Visual Acuity and the Correlation With Histopathologic Analysis of Descemet’s Membrane in Fuchs’ Corneal Dystrophy. Invest. Ophthalmol. Vis. Sci. 2010;51(13):751.
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We hypothesize that secondary stromal changes in Fuchs' dystrophy persist after Descemet’s stripping endothelial keratoplasty (DSEK) which may affect the post-operative visual outcome. In this study, we created a histologic grading system and correlated post-DSEK visual acuity with the severity of histologic changes in Descemet’s membrane (DM). The study is currently on-going, but preliminary data are presented below.
Preliminary data from 51 eyes has been evaluated. Eight eyes were excluded due to retinal disease, glaucoma or insufficient data. A histopathologic grading system was developed to evaluate Descemet’s membrane in specimens obtained after DSEK surgery. This system integrates various histologic features, including: density of guttae, extent of involvement of DM with guttae, size of guttae, average DM thickness, presence of DM lamination, embedded guttae, and quantity of endothelial cells. Based on the grading system, there were 20 mild and 23 severe cases. Prospective clinical data including post-DSEK visual acuity was obtained at 2, 3 and 6 months. Cases with better than 20/40 postoperative visual acuity at 6 months were termed "better visual outcome", while cases with 20/40 acuity or worse, were termed "worse visual outcome". Both pathologic and clinical data were correlated.
In 26 (61%) cases, post-DSEK visual acuity correlated with the histologic grading of Fuchs’ dystrophy severity. Ten cases with better visual outcome and sixteen cases with worse visual outcome were correctly predicted by the histologic grading system.
Our histologic grading system demonstrated a high positive predictive value for post-DSEK visual outcome. Results suggest that severe Fuchs’ dystrophy is associated with stromal changes which affect post-DSEK visual acuity. Early DSEK surgery in Fuchs’ dystrophy could prevent formation of these secondary stromal changes possibly leading to better post-operative visual outcomes.
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