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First Author: A.Ivarsen DENMARK
Co Author(s): J. Hjortdal N. Aagaard J. Hedegaard H. Sejersen C. Møller
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Descemets stripping automated keratoplasty (DSAEK) is the most frequently performed treatment for visually significant endothelial dystrophy. The endothelial dysfunction as well as the surgery, cause a transient increase in corneal hydration; however, it remains unknown whether permanent changes in the recipient corneal thickness occur.
Department of Ophthalmology, Aarhus University Hospital
From August to December 2012, 129 eyes of 93 patients attending routine clinical examination after DSAEK were examined with Pentacam and spectral domain OCT (Heidelberg Spectralis). In 78 eyes, previous Pentacam or OCT examinations allowed evaluation of temporal changes. Recipient corneal thickness (RCT) and donor lamella thickness (DLT) were determined from both imaging modalities. Light scattering (densitometry) from the centre of the cornea was determined from Pentacam examinations. Changes in visual acuity (CDVA), densitometry, RCT, and DLT were correlated using Pearsons correlation.
Using SD-OCT, RCT averaged 490ḟ31 ?m after DSAEK. RCT appeared to increase from 479ḟ31 ?m after 6 months (n = 28) through 488ḟ33 ?m after one year (n = 66) to 496ḟ29 ?m after 2 years (n = 45) and 505ḟ22 ?m after 3 to 6 years (n = 20). Similar changes were observed using Pentacam. In patients with repeat measurements, RCT increased 8 ±15 ?m from 6 months to 1 year (p = 0.001; n = 30), 10ḟ12 ?m from 1 to 2 years (p < 0.001; n =31), and 5ḟ12 ?m from 2 to 3 or more years after surgery (p = 0.06; n =8). RCT was correlated with CDVA (R2 = 0.09; p <0.001); with thicker corneas having better visual acuity. After DSAEK, average DLT was 142ḟ48 ?m, with an apparent decrease from 151ḟ50 ?m after 6 months to 136ḟ46 ?m after 2 years. There was no significant correlation between DLT and CDVA. Postoperative central corneal densitometry averaged 14 ±2 units after DSAEK, and correlated significantly with time (R2 = 0.11; p <0.001) and CDVA (R2 = 0.16; p <0.001); lower densitometry causing better CDVA. No correlation was found between densitometry and RCT.
In patients treated with DSAEK for endothelial dystrophy, the post-operative RCT was thinner than expected. RCT increased gradually over time, suggesting an initial wash-out of stromal ground-substances caused by dystrophic or post-operative edema, and subsequent resynthesis of extracellular material. CDVA correlated with RCT as well as corneal densitometry, suggesting that changes in the recipient cornea influence upon the postoperative visual acuity. Given the observational nature of the study, results should be interpreted cautiously.