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L. S. Seery, J. W. McLaren, S. V. Patel; Wavefront Aberrations After Descemet-Stripping Endothelial Keratoplasty for Fuchs’ Endothelial Dystrophy. Invest. Ophthalmol. Vis. Sci. 2010;51(13):760.
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To compare whole eye high-order aberrations (HOAs) between pseudophakic eyes after Descemet-stripping with endothelial keratoplasty (DSEK) and pseudophakic eyes with otherwise normal corneas.
Whole-eye wavefront errors were measured by using a Hartmann-Shack aberrometer (VISX Wavescan) in 16 eyes at 6 months, 17 eyes at 12 months, and 11 eyes at 24 months after DSEK. In all cases, DSEK was performed for Fuchs’ dystrophy through a 5-6 mm scleral incision, and the graft was prepared with a microkeratome. All DSEK eyes were pseudophakic, and were compared to 27 pseudophakic eyes (with otherwise normal corneas) implanted with the same type of intraocular lens. High-order aberrations were calculated over a 3-mm pupil and decomposed into Zernicke polynomials to the 6th order. Low-contrast visual acuity (LCVA) was measured by using a 10% ETDRS chart under photopic conditions (screen brightness, 139 cd/m2). HOAs were compared between DSEK and pseudophakic eyes by using generalized estimating equation models to account for possible correlation between fellow eyes of the same subject.
The aberrometer could not acquire data in 5 eyes at 6 months, 4 eyes at 12 months, and 1 eye at 24 months after DSEK. Total HOAs in the remaining DSEK eyes at 6 months (0.14 ± 0.05 µm; n=11; root-mean-square wavefront error), 12 months (0.13 ± 0.05 µm; n=13), and 24 months (0.13 ± 0.06 µm; n=10) were higher than in healthy pseudophakic eyes (0.07 ± 0.04 µm, n=27; p≤0.003). Total HOAs at 6 months after DSEK did not differ from those at 24 months (p=0.62). Trefoil was higher in eyes after DSEK at 6 months (0.09 ± 0.04 µm), 12 months (0.08 ± 0.04 µm), and 24 months (0.09 ± 0.06 µm; n=10), than in pseudophakic eyes (0.04 ± 0.02 µm; p≤0.004). HOAs did not correlate with LCVA within the DSEK group, but when DSEK and healthy pseudophakic eyes were combined, total HOAs correlated with LCVA at 6 months (r=0.58, p<0.001, n=38), 12 months (r=0.35, p=0.01, n=40), and 24 months (r=0.34, p=0.03, n=37).
Total HOAs and trefoil are higher in pseudophakic eyes after DSEK than in pseudophakic eyes with otherwise normal corneas. The differences in high-order aberrations can be attributed to the optical properties of the cornea after DSEK, possibly the posterior graft surface. Increased HOAs after DSEK might contribute to decreased vision.
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