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B. E. Miller, S. Pantanelli, R. Sabesan, M. DeMagistris, X. Cai, K. Huxlin, G. Yoon, H. Hindman; Evaluation of Corneal Wound Healing and Ocular Optics After Descemet’s Stripping With Automated Endothelial Keratoplasty (DSAEK). Invest. Ophthalmol. Vis. Sci. 2010;51(13):769.
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© ARVO (1962-2015); The Authors (2016-present)
To prospectively characterize the wound healing response and postoperative ocular optics of patients undergoing DSAEK.
Ten patients with Fuchs’ endothelial dystrophy requiring DSAEK surgery have been enrolled in a prospective, observational study. To date, data has been collected pre-operatively and at 4 and 12 weeks after surgery in 4 patients. At each time point, an anterior segment OCT and customized computer software were used to determined corneal radii of curvature, corneal thickness, and the amount of haze. The presence of higher-order aberrations (HOA) was evaluated using a Shack-Hartmann wavefront sensor. Wavefront aberrations were calculated from spot arrays over a 5 mm pupil size using Zernike polynomial expansion up to the 10th order. Best-corrected visual acuity (BCVA) was also assessed.
At 12 weeks the following trends were observed from preoperative values. BCVA was 20/60 or better compared to baseline (range 20/60- 20/150). Mean posterior radius of curvature decreased significantly (5.92 mm vs 7.38 mm, p<0.0001), while mean anterior and stromal-interface radii of curvature increased non-significantly (7.97 mm vs 7.87 mm, 8.06 mm vs 7.93 mm). Mean host stromal thickness decreased significantly at 12 weeks from preoperative values (477.9 µm vs 578.4 µm, p<0.0001). Mean total (donor and host stroma) cornea thickness increased significantly (683.2 µm vs 630.1 µm, p<0.0001). Corneal light-backscatter measurements showed a second peak corresponding to the donor-host interface post-DSAEK. Higher-order root mean square wavefront error was 0.39 µm (± 0.22), and the most dominant HOA (N=2) was secondary astigmatism (0.2 µm), making up 31% of the variance of HOA (5mm pupil).
Increased total corneal thickness and decreased posterior radius of curvature can be attributed to the addition of the donor tissue while the decrease in host stromal thickness is likely a result of deturgescence secondary to a functioning endothelium. Additional subjects and time points will help us to better characterize the role of corneal light scatter and HOAs in post-DSAEK patients.
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