Abstract
Purpose :
To determine changes in best-corrected visual acuity (BCVA), refractive error, and central corneal thickness (CCT) during the first decade after Descemet stripping endothelial keratoplasty (DSEK).
Methods :
Medical records of all consecutive eyes (including the learning curve) undergoing DSEK for Fuchs endothelial corneal dystrophy (FECD) by one surgeon were reviewed and eyes with comorbidities prior to DSEK, except for cataract, were excluded. DSEK was performed through a 4.5-6 mm temporal scleral tunnel and all eyes were pseudophakic postoperatively. Postoperative changes in BCVA, spherical equivalent refractive error, refractive cylinder (vector analysis), and CCT, were assessed by using generalized estimating equation models (paired analyses). Postoperative data were excluded if new comorbidities affected vision or CCT.
Results :
Of 130 eyes (81 subjects) undergoing DSEK for FECD, 34 eyes were excluded because of preoperative comorbidities. BCVA improved between 6 months (0.18 ± 0.12 logMAR; Snellen equivalent, 20/30) and 5 years (0.10 ± 0.10 logMAR; 20/25; n=74, p<0.001) and then remained stable at 10 years (0.09 ± 0.10 logMAR, n=48, p=0.22 vs. 5 years). There was a myopic shift of -0.20 ± 0.51 D between 6 months and 5 years (n=60, p=0.002) that remained stable at 10 years (-0.09 ± 0.44 D; 20/25; n=33, p=0.33 vs. 5 years). Refractive cylinder drifted with-the-rule between 6 months and 5 years (0.76 D axis 075; n=65, p<0.001) and between 5 and 10 years (0.75 D axis 082; n=34, p<0.001). CCT was stable between 6 months (672 ± 57 µm) and 5 years (677 ± 55 µm, n=63, p=0.47), but increased at 10 years (702 ± 60 µm, n=39, p=0.001). The change in BCVA was not correlated with the change in CCT during either interval (p≥0.74).
Conclusions :
After DSEK for FECD, BCVA improves through 5 years and remains stable thereafter in functioning grafts. Changes in BCVA are not associated with changes in CCT. Increasing with-the-rule astigmatism after DSEK might be related to late changes in the temporal incision.
This abstract was presented at the 2022 ARVO Annual Meeting, held in Denver, CO, May 1-4, 2022, and virtually.