Objective To compare a one-step (rapid) application of negative pressure (vacuum)

Purpose To describe 3 year visual outcomes and correlation with graft thickness in eyes following Descemet Stripping Automated Endothelial Keratoplasty (DSAEK). Methods Retrospective case series of 106 consecutive eyes that underwent DSAEK. We recorded clinical characteristics , best‐corrected visual acuity (BCVA) and serial measurements of central graft thickness and total central corneal thickness using anterior segment optical coherence tomography over a 3‐year follow‐up. Correlation analysis of preoperative and postoperative graft thickness with BCVA at 1, 2 and 3 years were performed. Results Mean age of recipients was 64.5 years (± 11.8) years. The median preoperative logarithm of the minimal angle of resolution (logMAR) BCVA was 0.71. There was significant improvement in post‐operative BCVA at 1‐year (median improvement in BCVA 0.41, P<0.001), but no significant improvement in BCVA after 2 year post operatively (P=0.563). Likewise, median central graft thickness significantly decreased post‐operatively over the first year (190um vs 166 um, P<0.001), but no significant reduction of graft thickness after 2 years post‐operatively (P=0.17). There were no correlations between preoperative graft thickness and BCVA logMAR at 1 year (Spearman=‐0.187; p= 0.069), 2 year (Spearman= ‐0.049; p= 0.650) or at 3 year (Spearman=‐0.068; p= 0.614). There were also no significant correlations of logMAR BCVA with post‐operative graft thickness by AS‐OCT at any time point. Conclusion Visual acuity significantly improves after DSAEK over the first year postoperatively. However, no correlation can be found between both preoperative and postoperative graft thickness and BCVA over 3 year follow up.