Corneal Light Scatter After Ultrathin Descemet Stripping Automated Endothelial Keratoplasty Versus Descemet Membrane Endothelial Keratoplasty in Descemet Endothelial Thickness Comparison Trial: A Randomized Controlled Trial

Abstract

Purpose: To compare the degree of corneal light scatter as measured by densitometry in ultrathin Descemet Stripping Automated Endothelial Keratoplasty (UT-DSAEK) and Descemet Membrane Endothelial Keratoplasty (DMEK) in the Descemet endothelial thickness comparison trial. Methods: This was a prespecified secondary analysis of the Descemet endothelial thickness comparison trial, which was a prospective, randomized controlled trial. Subjects with isolated endothelial dysfunction were enrolled and were randomized to either UT-DSAEK or DMEK. Corneal opacity was quantitatively measured by Pentacam densitometry (OCULUS) at 3, 6, and 12 months. Results: Fifty eyes of 38 patients were enrolled at the Casey Eye Institute at Oregon Health & Science University and the Byers Eye Institute at Stanford University. Corneal densitometry for the anterior and posterior layers improved in both UT-DSAEK and DMEK after surgery. The decrease was more pronounced in the posterior layer for both groups. However, there was no difference in the degree of corneal light scatter between UT-DSAEK and DMEK at postoperative month 12, and no difference in change in densitometry was observed between the 2 arms from baseline to month 12. Conclusions: Both UT-DSAEK and DMEK experience an improvement in the degree of corneal light scatter after surgery. However, there was no difference in densitometry between the 2 groups at month 12. Therefore, other factors such as higher order aberrations in the posterior cornea rather than stromal–stromal interface haze mediate the superior visual outcomes in DMEK compared with UT-DSAEK.

Long-term Outcomes in Fellow Eyes Comparing DSAEK and DMEK for Treatment of Fuchs Corneal Dystrophy

“…They reported that the posterior corneal surface had significantly less coma and total HOA in DMEK compared to ultrathin DSAEK as well as less posterior trefoil, secondary astigmatism and tetrafoil. Finally, Hirabayashi and colleagues 46 measured corneal light scatter between UT-DSAEK and DMEK and found no difference in the Pentacam densitometry between the two groups at 3,6 and 12 months with both procedures improving after the procedures. They felt that the HOA in the posterior cornea were responsible for any differences between the two procedures rather than the stromal-stromal interface haze.…”

Comparative Analysis of Corneal Parameters in Swept-Source Imaging between DMEK and UT-DSAEK Eyes

“…On the other hand, Torras-Sanvicens et al did not observe statistically significant differences in total, anterior or posterior HOAs 12 months after surgery [ 6 ], which is in line with the results of other groups [ 19 ]. Altogether, it should be highlighted that the published data differ in terms of the operating techniques, corneal topographer device, definitions of UT-DSAEK grafts below 100 μm [ 8 , 9 , 20 ] or below 130 μm [ 3 , 7 ] and selection of study groups used, which makes it impossible to draw definite conclusions. It is worth mentioning that none of the previous studies compared the postoperative corneal curvature and topography parameters with their baseline values recorded preoperatively.…”

Loss of Corneal Nerves and Corneal Haze in Patients with Fuchs’ Endothelial Corneal Dystrophy with the Transcription Factor 4 Gene Trinucleotide Repeat Expansion

“…To calculate densitometry values for the central 0 to 6 mm optical zone, the 0 to 2-mm and 2 to 6-mm zones were combined using the methods previously described by Hirabayashi et al. 29 …”