Anterior Segment Optical Coherence Tomography of Post-Descemet Stripping Automated Endothelial Keratoplasty Eyes to Evaluate Graft Morphology and Its Association With Visual Outcome

Abstract

DSAEK grafts thinner than 100 μm are more regular than thicker ones. In eyes with Fuchs endothelial dystrophy that are otherwise healthy, thinner grafts yield significantly better BSCVA.

<p>Different graft thicknesses after Descemet stripping endothelial keratoplasty for bullous keratopathy in the two eyes of the same patient</p>

“…Graffi et al found that the regularity of the interface and posterior corneal surface is better in DSAEK grafts below 100 µm of thickness. According to the same authors, in eyes with Fuchs endothelial dystrophy that are otherwise healthy, thinner grafts yield significantly better CDVA, thus confirming the previous observation by Dickman et al13…”

“…Long-lasting corneal edema and irregularity of the anterior refractive surface may lead to changes in the anterior stroma that may hinder visual acuity after DSAEK 12. The lower would be the distance from the ideal plane of various parts of the same surface considered, the more regular would be the corneal shape at all levels (anterior, interface, and posterior surface) and this is related to lower ocular aberrations 13. Even though being a single case, in our report a substantial correlation from preoperative corneal thickness with preoperative and postoperative HOAs and CDVA was not shown.…”

Influence of Donor Thickness on Visual Acuity in Descemet’s Stripping Automated Endothelial Keratoplasty

“…[33] Graffi et al evaluated the relationship between graft thickness, regularity, and visual acuity in 89 eyes and concluded that DSAEK grafts thinner than 100 μm are also more regular than thicker ones, and that in Fuchs endothelial dystrophy thinner grafts result in better visual acuity. [34] Further research is recommended in determining which qualities of the lamellae, that is, either the thickness of the lamellae and their respective architecture or the interface with the recipient's cornea are responsible for better visual acuity postoperatively. Our results suggest that the goal after conventional DSAEK is to have postoperative lamellas thinner than 124 μm in the eye, as this will result in better postoperative visual acuity.…”

Reply

“…With a wider possible range of pachymetry values along different points, thicker grafts tend to have greater posterior corneal asymmetry, which in turn affects visual outcomes. 1,2 Conversely, when the intended graft thickness is <100 mm, as in ultrathin DSAEK, there is a greater probability of obtaining a regular and symmetric graft, thus resulting in better vision. 3 Although highly functional vision can still be achieved in a large number of cases, raising the bar for DSAEK must also involve standardized graft preparation that yields consistent graft quality.…”

“…2021;128:576e586) TO THE EDITOR: I read the results of the randomized controlled trial (RCT) of the complement C5 inhibitor avacincaptad pegol for geographic atrophy (GA). 1 The 2 main observations were that complement inhibition, compared with sham treatment, caused (i) a significant decrease in GA progression and (ii) an increase in exudative macular neovascularization (MNV). These observations are striking in that both were apparent also in the RCT of the C3 inhibitor pegcetacoplan, published within the last year.…”