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Predictability of visual acuity following Descemet stripping endothelial keratoplasty (DSEK)

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Session Details

Session Title: Cornea
Session Date/Time: Sunday 28/02/2016 | 08:30-11:00
Paper Time: 10:00
Venue: MC2 Room
First Author: : M.Tsatsos UK
Co Author(s): :    C. MacGregor   A. Turnbull   P. Hossain   D. Anderson     

Abstract Details


To assess the predictability of visual acuity after Descemet stripping endothelial keratoplasty.


Corneal Service, Department of Ophthalmology, University Hospital Southampton, UK.


34 Consecutive patients undergoing manually-dissected DSEK for Fuchs’ endothelial dystrophy or bullous keratopathy were prospectively studied. Patients with vision-limiting ocular comorbidities were excluded. Central graft and total corneal thicknesses were measured using anterior segment optical coherence tomography at 1 day, 1 week, 1 month, 3 months, 9 months and 12 months postoperatively. BCVA logMAR visual acuity was also recorded at each time-point. Correlations between graft thickness, total corneal thickness and visual acuity were calculated, and trends were analysed to determine the extent to which the postoperative course could be predicted.


Graft thickness reduced significantly between 1 day and 1 month postoperatively (p<0.05). After the first month, graft thickness continued to reduce but at a much slower rate. Statistically significant (p<0.01) positive (r 0.619) relationships between BCVA and GT. Graft thickness alone explains 37,5 % of the variability of logMar. The addition of time evolution increases the predictive ability to 40.4%. The inclusion of the diagnosis (FED or PBK) and type of operation (primary, combined or redo) variables invokes a highly non-significant improvement in the model's performance (p=0.524)


As graft thickness increases, visual acuity worsens in a predictable fashion. The standardized coefficients demonstrate the relative importance of graft thickness compared to the other variables, with graft thickness accounting for 37.5% of the total variability in visual acuity. A secondary finding is while patients at 365 days postoperatively have significantly better visual acuity than at 90 days postoperatively, there was no significant difference in acuity between 90 and 180 days. This confirms that for many patients, visual rehabilitation continues well beyond the first few postoperative months.

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