Elsevier

Ophthalmology

Volume 119, Issue 3, March 2012, Pages 528-535
Ophthalmology

Original article
Corneal Higher-Order Aberrations after Descemet's Membrane Endothelial Keratoplasty

Poster presented at: the annual meeting of Association for Research in Vision and Ophthalmology, May 1, 2011, Fort Lauderdale, Florida.
https://doi.org/10.1016/j.ophtha.2011.08.034Get rights and content

Purpose

We compared corneal higher-order aberrations (HOAs) in eyes after Descemet's membrane endothelial keratoplasty (DMEK), Descemet's stripping automated endothelial keratoplasty (DSAEK), and penetrating keratoplasty (PK), and in a control group that had not undergone surgery.

Design

Retrospective analysis of clinical data.

Participants

Thirty eyes of 30 patients who had undergone standard DMEK, 20 eyes of 20 patients after DSAEK, 20 eyes of 20 patients after PK, and 20 eyes of 20 controls were analyzed.

Methods

In addition to standard postoperative examinations, each participant was analyzed with the Pentacam high-resolution rotating Scheimpflug imaging system (Pentacam HR, Oculus, Wetzlar, Germany). Data were compared between groups.

Main Outcome Measures

Visual acuity and HOAs.

Results

The mean follow-up was 6.5±1.2 months after DMEK, 22.6±11.8 months after DSAEK, and 103.1±74.2 months after PK. There were no statistically significant differences for the anterior 4.0-mm zones between the DMEK group and the controls or between the DMEK and DSAEK groups. The DMEK procedure compared with PK showed statistically significant differences in all terms for the 4.0-mm zones. All combined Zernike terms for mean posterior aberrations of the central 4.0-mm zones showed statistically significant higher aberrations for DMEK compared with controls. The DMEK procedure compared with DSAEK showed statistically significant lower mean values for all combined Zernike terms, except for coma and coma-like terms in the central 4.0-mm zones of the posterior corneal surface. Compared with PK, DMEK showed statistically significant lower mean values for all combined Zernike terms for the central 4.0-mm zones of the posterior corneal surface, except for spherical aberration (SA) and SA-like terms. Best spectacle-corrected visual acuity (BSCVA) after DMEK was statistically significantly better than after DSAEK (P = 0.001) and PK (P = 0.005). There was no statistically significant difference when BSCVA was compared with controls (P = 0.998).

Conclusions

Both DSAEK and PK exhibit increased posterior corneal HOAs even years after surgery. Patients receiving DMEK display only slight changes in posterior corneal HOAs.

Financial Disclosure(s)

Proprietary or commercial disclosure may be found after the references.

Section snippets

Patients

Thirty eyes of 30 patients (18 male, 12 female) aged 43 to 85 years (mean 68.8±9.5 years) who had undergone DMEK, 20 eyes of 20 patients (9 male, 11 female) aged 50 to 87 years (mean 69.7±10.2 years) who had undergone DSAEK, 20 eyes of 20 patients (12 male, 8 female) aged 24 to 84 years (mean 53.2±18.5 years) who had undergone PK, and 20 eyes of 20 age-matched (mean age 74.4±10.7 years) phakic controls (10 male, 10 female) consisting of patients who had undergone cataract surgery of the fellow

Results

For the final analysis of BSCVA, 8 patients (1 in the DMEK group, 5 in the DSAEK group, 1 in the PK group, and 1 in the control group) were excluded because of preexisting conditions limiting visual acuity: macular degeneration (2), diabetic cystoid macular edema (2), retinal vein occlusion with cystoid macular edema (1), amblyopia (1), and advanced glaucomatous optic atrophy (2). Patients were examined 6.5±1.2 months after DMEK, 22.6±11.8 months after DSAEK, and 103.1±74.2 months after PK.

Discussion

The advent of DMEK allows replacement of the host's diseased endothelium practically without alteration of the posterior anatomy of the cornea.7, 8, 9, 10, 11, 12 The hypothesis that ultra-thin grafts produce the best results is supported by initial experience with DMEK, with eyes exhibiting excellent visual acuity even in the early postoperative period.12, 16, 22, 23

The results of this study indicate that DMEK seems to be superior to DSAEK with respect to induced posterior corneal surface HOAs

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  • Cited by (0)

    Manuscript no. 2011-84.

    Financial Disclosure(s): The author(s) have made the following disclosure(s): Friedrich E. Kruse is a consultant for Santen.

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