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Matthew Duggan, Jennifer Rose-Nussbaumer, Charles C Lin, Ariana Austin, Winston Chamberlain; DMEK results in significantly less higher-order aberration than UT-DSAEK: Results from the DETECT trial.. Invest. Ophthalmol. Vis. Sci. 2018;59(9):1575. doi: https://doi.org/.
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© ARVO (1962-2015); The Authors (2016-present)
To analyze a 3- and 6-month secondary outcome of the DETECT randomized, controlled, double masked trial comparing Ultra-Thin Descemet Stripping Endothelial Keratoplasty (UT-DSAEK) to Descemet Membrane Endothelial Keratoplasty (DMEK): Higher-order aberrations from anterior, posterior, and combined corneal surfaces.
At 3 months and 6 months post-operatively, patients with endothelial dysfunction from the DETECT trial underwent three-dimensional scans of the anterior segment with Scheimpflug imaging (Pentacam). Zernike vector values of the anterior, posterior, and combined corneal surfaces were calculated at 4.0- and 6.0-mm-diameter optical zones using the Pentacam software, based on relative height data between the cornea and a best-fit sphere reference surface. Root mean square deviations of individual aberrations (Coma, Trefoil, Spherical Aberration, Oblique Astigmatism, Tetrafoil) and total higher-order sum of Zernike orders 3-8 (Total HOA) were calculated for each group. Two-tailed Student’s t-test was used for statistical analysis.
216 patients were screened and 50 eyes of 38 patients were randomized to DMEK (25 eyes) or UT-DSAEK (25 eyes). At 3 months, the DMEK group had significantly less Coma (P≤0.018), Trefoil (P≤0.019), Oblique Astigmatism (P≤0.005), Tetrafoil (P≤0.005), and Total HOA (P<0.001) of the posterior corneal surface at both 4.0- and 6.0-mm-diameter optical zones. Similarly, at 6 months, the DMEK group had significantly less Coma (P≤0.003), Trefoil (P≤0.007), Oblique Astigmatism (P≤0.006), and Total HOA (P<0.001) of the posterior corneal surface at both 4.0- and 6.0-mm-diameter optical zones. At both 3 and 6 months, no significant differences in spherical aberration or HOAs of the anterior or combined corneal surfaces existed between groups.
DMEK resulted in significantly less HOAs of the posterior corneal surface compared to UT-DSAEK. This may contribute to significantly better BSCVA in the DMEK group (manuscript submitted). However, corneal light-scattering, graft-host interface optical disparities, or differences in graft shape may also influence visual acuity. The loss of significant difference in tetrafoil from 3 to 6 months post-operatively may indicate that HOAs shift as grafts remodel over time. Longer term analyses of these factors with extended follow-up will better characterize the clinical outcomes of DMEK and UT-DSAEK.
This is an abstract that was submitted for the 2018 ARVO Annual Meeting, held in Honolulu, Hawaii, April 29 - May 3, 2018.
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