Change in Central and Peripheral Corneal Thickness in UT-DSAEK and DMEK in the Descemet Endothelial Thickness Comparison Trial

Abstract

Purpose : Differential changes in corneal and graft shape after endothelial keratoplasty may effect post-operative vision and refraction. The changes in ultrathin Descemet stripping automated endothelial keratoplasty (UT-DSAEK) and Descemet Membrane Endothelial Keratoplasty (DMEK) graft and host corneal thickness over time have not been examined in a randomized controlled trial. We compared central and peripheral corneal thickness over time following UT-DSAEK and DMEK in the Descemet Endothelial Thickness Comparison Trial (DETECT).

Methods : A total of 50 eyes of 38 patients with isolated endothelial dysfunction from Fuchs endothelial dystrophy or pseudophakic bullous keratopathy were randomized to receive DMEK or UT-DSAEK. Central (0-0.3 mm from center), mid peripheral (1.4-1.6 mm), and peripheral (2.7-3.0 mm) host and graft corneal thickness data were obtained using anterior segment OCT (Optovue RTVue-XR®) with a horizontal line scan approximately mid pupil at 3 months and 12 months post-operatively. Paired T-tests were used to compare graft and host corneal thickness at each time point in 19 UT-DSAEK eyes and 19 DMEK eyes.

Results : After UT-DSAEK at 3 months (p=0.002) and 12 months (p =0.03), there was statistically significant central graft thickening compared to baseline graft thickness. There was no significant change in mid peripheral (p=0.25) and peripheral (p=0.22) graft thickness between 3 months and 12 months post-operatively. There was no difference in host central (p=0.92) or mid peripheral (p=0.27) cornea thickness at 3 months and 12 months. There was statistically significant host cornea peripheral thinning at 12 months compared to 3 months post-operatively (p=0.001). By comparison, there was no significant change after DMEK in central (p=0.25) and peripheral (p=0.22) corneal thickness between 3 and 12 months post-operatively.

Conclusions : 3 and 12 months following UT-DSAEK, central graft thickness increased compared to pre-surgical values. Peripheral host cornea thickness decreased at 12 months compared to 3 months following UT-DSAEK while peripheral graft thickness did not change. There was no significant change between 3 and 12 months in central or peripheral corneal thickness after DMEK. Differential changes in thickness may effect corneal optics.

This is a 2020 ARVO Annual Meeting abstract.