Effects of Graft Thickness and Asymmetry on Visual Gain and Aberrations After Descemet Stripping Automated Endothelial Keratoplasty

Abstract

Importance: Understanding the contribution of graft thickness and asymmetry to visual gain and posterior corneal (PC) higher-order aberrations (HOAs) may assist optimizing visual outcomes after Descemet stripping automated endothelial keratoplasty (DSAEK).Objective: To investigate the effects of graft thickness and asymmetry on visual gain and aberrations after DSAEK.Design: Retrospective analysis of an interventional case series of eyes undergoing DSAEK. Visual gain was defined as the difference between preoperative and 6-month postoperative best-corrected visual acuity in logMAR equivalents. Graft thickness was measured by anterior-segment optical coherence tomography. Corneal topography and HOAs were measured by Scheimpflug imaging. Raw posterior corneal (PC) elevation data were exported and fitted against a bestfitted sphere, providing a measure of donor lenticule asymmetry. Correlation analysis was performed among visual gain, graft thickness, graft asymmetry, and PC HOAs.

Determinants of visual quality after endothelial keratoplasty

“…Thin grafts have been found to have fewer irregularities than thick grafts, 30,108 and it may be this, rather than thickness per se, that is the crucial aspect. Further work is required to elucidate the precise role of corneal thickness in visual quality after EK, and to establish whether a cut-off point exists with graft thickness, below which significantly better visual outcomes are achieved, independent of the nature of the interface.…”

Visual Outcomes and Graft Thickness in Microthin DSAEK—One-Year Results

“…4,9,16 In DSAEK, endothelial graft thickness has been suggested as a factor that influences visual results. 8,10,11,[17][18][19][20][21] To date, there has been no randomized controlled trial to assess the effect of DSAEK graft thickness on visual acuity; however, the preliminary report of such a trial seems to suggest a favorable outcome toward thin DSAEKs. 22 Thin DSAEK techniques seem to offer better visual results compared with conventional DSAEK with graft thickness above 130 mm.…”

“…3,[6][7][8] On the contrary, thin DSAEK offers technical advantages of conventional DSAEK while improving on visual outcomes. [8][9][10][11] Current thin DSAEK techniques include the use of 2 specialized microkeratome passes (ultrathin DSAEK) or, a femtosecond laser with or without a microkeratome. 4,5,9 There are a variety of terms used to describe such grafts (thin DSAEK, ultrathin DSAEK), and the widely accepted definition of thin grafts carries a central graft thickness (CGT) of ,100 to 130 mm.…”

Assessment of the Accuracy and Cut-Failure Rates of Eye Bank-Cut Corneas for Use in Endothelial Keratoplasty

“…2 This is because of the increasing body of literature on the improved visual outcomes in patients receiving tissue with thinner central corneal thicknesses. [6][7][8][9] With thinner tissue (ie, traditional DSAEK graft of approximately 150 mm vs. ultrathin DSAEK graft of less than 100 mm), however, comes a higher risk of perforation. Consequently, there are substantial cost considerations the surgeon must make as perforation in the OR may not only cost the surgeon the price of replacing the tissue, but one might also need to procure a second cornea onsite as backup.…”