Correlation between visual acuity and interface reflectivity measured by pentacam following DSAEK

Abstract

. Purpose: Descemet‐stripping automated endothelial keratoplasty (DSAEK) is an advanced method of lamellar endothelial keratoplasty. In comparison with penetrating keratoplasty, visual rehabilitation seems to be faster. Final visual outcome of DSAEK, however, seems to be limited, especially in comparison with Descemet membrane endothelial keratoplasty (DMEK). DSAEK cases without graft failure often do not show any definite correlate for the reduced optical performance. In this study, we tried to correlate visual acuity following DSAEK with interface reflectivity as measured by a rotating Scheimpflug system. Methods: We examined 14 eyes of 13 patients with the pentacam for 2–11 months following DSAEK. Reflectivity of the interface region in the centre of the optical axis as well as central corneal thickness was determined. Statistical correlation between interface reflectivity and best spectacle‐corrected visual acuity, central corneal thickness and follow‐up time was drawn (multifactorial linear regression analysis). Results: Statistically significant correlation between interface reflectivity and BSCVA as well as follow‐up time was found. Reflectivity was highest in regions of interface (metal) particles. There was no statistically significant correlation between interface reflectivity and central corneal thickness. Conclusion: We present a measurable correlate for reduced visual outcome following DSAEK despite a clear graft. Inverse correlation between interface reflectivity and best spectacle‐corrected visual acuity (BSCVA) indicates that irregularities or scarring in the interface region may influence the optical quality following DSAEK.

Relationship Between Tissue Unscrolling Time and Endothelial Cell Loss

“…Because the cohort was only adequately sampled for the age range of 57 to 75, our findings are best applied to donors of this age group. However, based on the recommendations of others 6,8,23 in the peer-reviewed literature and unpublished data from eye banks, it is likely that most DMEK surgeons share a practice that is similar to ours in the selection of donor age for DMEK surgery. Although this may, in effect, render the sampling bias of this study moot, surgeon preferences in DMEK may still be of continued interest in future studies.…”

Determinants of visual quality after endothelial keratoplasty

“…120 While little is known for certain regarding the role of the graft-host interface in visual performance post-EK, it is thought that interface opacity induces HOAs, loss of contrast sensitivity 140 and loss of acuity. 51 Convergence between the differently orientated host and donor stromal collagen fibres at the interface is considered to be a source of optical aberrations in DSEK / DSAEK -a situation theoretically overcome by DMEK.…”

Postmortem Ultrastructural Analysis of a Cornea Transplanted With Descemet Membrane Endothelial Keratoplasty

“…Other authors have shown this to be the cause of nonoptimal visual rehabilitation after surgery. 13 The stroma-stroma interface seen in Descemet stripping endothelial keratoplasty-/DSAEK-operated patients is easily detected upon slit-lamp examination. Suh et al 14 examined failed DSAEK grafts histopathologically to evaluate the etiology of the graft failure, and they too noted fibrocellular proliferation in the DSAEK lenticule-host stroma interface in 58% of cases.…”