Impact of graft thickness on visual acuity after Descemet's stripping endothelial keratoplasty

Abstract

Objective To evaluate the relationship, over time, between central graft thickness and visual acuity following Descemet's stripping endothelial keratoplasty (DSEK). Methods A retrospective analysis of 70 consecutive cases of DSEK. All donor lenticules were dissected manually. Serial postoperative measurements of central graft and total corneal thicknesses were made using anterior segment optical coherence tomography. Visual acuity, refraction and patient demographics were collected from case notes. The correlation between central graft thickness and visual acuity at serial time points was calculated. Results The median age at surgery was 75 years (lower quartile (LQ) 66, upper quartile (UQ) 83, range 36-90 years). Nineteen eyes were excluded from statistical analysis, leaving 51 eyes of 46 patients remaining. Last follow-up occurred a median of 12 months postoperatively (LQ 6, UQ 23, range 4-38 months). The median preoperative visual acuity was 0.71 logarithm of the minimum angle of resolution (logMAR), improving to 0.34 logMAR postoperatively (p<0.001, n=43). Median graft thickness decreased from 209 μm at day 1 to 142 μm at last follow-up (p<0.001). No statistically significant correlation was found between central total corneal thickness and visual acuity at any time point. Except for a single time point, no statistically significant correlation was found between central graft thickness and visual acuity. Conclusion There is no clear association between central graft, or total corneal, thickness and visual acuity following DSEK.

Presoaking with BSS used for thin manually dissected DSEK (TMDSEK): a viable option for thin DSEK

“…5 The variation in thickness was small, showing that this technique can produce consistent results. Vision with TMDSEK was significantly better even at 1 month following surgery, despite the small number of cases.…”

“…The rest of the DSEK surgery was performed as previously described 5 with an injectable device (The Endosaver, Ocular Systems, Inc., Winston-Salem, NC, USA) through a 4.5-mm incision. 5 …”

Determinants of visual quality after endothelial keratoplasty

“…Determinants of visual quality after endothelial keratoplasty 116 Graft thickness reduced significantly between day one and week one, and again between week one and month one post-operatively, after which it stabilised. 116 Visual rehabilitation took longer, improving progressively up to six-months postoperatively.…”

“…116 Visual rehabilitation took longer, improving progressively up to six-months postoperatively. Moderate, significant correlation was found between graft thickness and visual acuity at six-months postoperatively.…”

Combined Use of a Femtosecond Laser and a Microkeratome in Obtaining Thin Grafts for Descemet Stripping Automated Endothelial Keratoplasty: An Eye Bank Study

“…The influence of endothelial graft thickness on visual acuity in DSAEK is controversial, with some authors reporting better results with thinner grafts and others finding no correlation (10)(11)(12)(13)(14)(15). However, studies evaluating this subject have either focused on relatively thick grafts (160-170 µm) or on grafts prepared by manual dissection (11)(12)(13)(14)(15). When grafts having less than 130 µm are evaluated, a positive correlation between thickness and visual acuity is obtained (9,10), suggesting that an effect may exist under a certain thickness.…”