Abstract
Purpose: :
To prospectively characterize the wound healing response and postoperative ocular optics of patients undergoing DSAEK.
Methods: :
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.
Results: :
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).
Conclusions: :
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.
Keywords: cornea: endothelium • transplantation • aberrations