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Thin versus ultrathin Descemet"s endothelial keratoplasty (DSEK): an evaluation of the visual acuity and hyperopic changes
Session Title: Cornea surgical I
Session Date/Time: Tuesday 08/10/2013 | 08:00-10:30
Paper Time: 08:12
Venue: Forum (Ground Floor)
First Author: : C.MacGregor UK
Co Author(s): : M. Tsatsos A. Konstantopoulos P. Hossain D. Anderson
To determine whether there was a significant hyperopic shift in patients undergoing Descemets endothelial keratoplasty (DSEK) and to evaluate the visual changes in patients with thin grafts versus ultrathin DSEK grafts.
DSEK has revolutionised the treatment of endothelial dysfunction due to quicker visual rehabilitation and maintenance of the structural integrity of the tissue compared to traditional penetrating keratoplasty. Although there is still debate whether ultrathin grafts lead to better visual outcome, there is a growing tendency, with refinement of technique, to trend towards thinner grafts. Our study was performed on patients undergoing surgery at Southampton University NHS foundation trust.
Data was collected prospectively, over a 2-year period. The sphere measurements and spherical equivalents (SE) pre and post-operatively were compared in patients with DSEK grafts <134,6?m thick and patients with DSEK grafts > 134.6?m. The 134.6?m division between thin and ultrathin DSEK grafts was determined by a regression tree analysis of data collected over time. Comparing thickness and vision. Grafts of thickness <134.6?m (Ultrathin Grafts) were associated with visual acuity <0.355. The visual acuity in patients undergoing DSEK and patient characteristics were examined and compared between patients with grafts <134.6 and > 134.6?m. Patients with co-morbidities, such as ARMD and end stage glaucoma, likely to account for a reduced visual potential were excluded.
Mean preoperative sphere and SE in patients with grafts <134.6?m was 0.79 and 0.30. Post-operative sphere and spherical equivalent was 0.875 and 0.25 respectively. Mean preoperative sphere and SE in patients with graft >134.6?m was -0.75 and -0.67 respectively. Postoperative sphere and SE was 0 and -0.375 respectively. There was no statistical difference in pre-operative and post-operative sphere measurements or SE in either group. In visual outcome study, the mean graft thickness in the ultrathin and thin group was 82.96?m and 184?m respectively. Mean preoperative Logmar visual acuity the ultrathin group was 0.995 and was 0.2624 and 0.20 at 6 months and 12 months respectively. Mean pre-operative visual acuity the > 134.6?m group was 0.8 and was 0.33 and 0.3 at 6 and 12 months respectively. There was statistical difference in visual outcome between thin and Ultrathin groups at last follow up (12 months) p = 0.013.
Ultrathin DSEK grafts resulted in better visual acuity than think DSEK grafts. Hyperopic shift was not found to be significant in either of the two groups.