Corneal transplants

Visual acuity and quality of vision after ultra-thin DSAEK and DSAEK

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Ultra-thin Descemet’s stripping automated endothelial keratoplasty (UT-DSAEK) offers faster and better visual recovery compared to traditional DSAEK, according to Mor Dickman MD, PhD, of Maastricht University, The Netherlands. “Our randomised, multicentre study showed that there was faster and better recovery of best spectacle-corrected visual acuity (BSCVA) and faster recovery of contrast sensitivity with UT-DSAEK compared to standard endothelial keratoplasty,” said Dr Dickman. Recent years have seen a massive increase in the number of endothelial keratoplasty procedures for diseases such as Fuchs dystrophy in The Netherlands, said Dr Dickman, mirroring the wider international trend. “In the last two decades, not only did endothelial keratoplasty replace penetrating keratoplasty as a treatment of choice, but the total number of grafts continues to rise steadily. Recovery of visual acuity, however, after endothelial keratoplasty is unpredictable. At the same time, we are seeing a paradigm shift towards earlier surgical intervention at lower levels of visual disability,” he said. To test the hypothesis that thinner grafts result in better vision, a randomised controlled trial of 66 patients was carried out in four tertiary ophthalmology clinics in The Netherlands comparing visual acuity and quality of vision in patients undergoing UT-DSAEK (defined as grafts thinner than 100 microns), and standard DSAEK which were grafts 200 microns in thickness. Looking at the visual acuity results, there was a high, statistically significant difference in BSCVA in favour of UT-DSAEK at three and six months. “At 12 months we found a difference of 0.07 logMar in favour of UT-DSAEK which equates to almost one Snellen line of vision,” said Dr Dickman. For contrast sensitivity, results were better at three months for patients in the UT-DSAEK group, but there was no difference between the groups at six and 12 months. Preoperative straylight values did not differ between groups, but younger patients were found to have significantly higher straylight scores compared with age-matched phakic controls. “Post-op straylight values in younger patients returned to normal compared to age-matched pseudophakic controls, suggesting that elevated straylight may play a role in the decision of young Fuchs’ patients to seek surgical treatment,” said Dr Dickman. Another key finding was that early posterior corneal higher order aberrations were lower after UT-DSAEK, perhaps contributing to faster recovery of visual acuity. “Vision-related quality of life continued to improve after the operation at three and 12 months irrespective of the technique used or patient age, thus giving hope to both younger and older patients with Fuchs dystrophy who need to undergo endothelial keratoplasty,” said Dr Dickman. Mor Dickman: mor.dickman@mumc.nl