Visual Recovery After Dmek Surgery: Predictive Role Of Preoperative Stromal Ripples

To assess the role of preoperative posterior stromal ripples (pre-PSR) on visual acuity recovery and final visual acuity after Descemet Membrane Endothelial Keratoplasty (DMEK) surgery.

Comparative case series retrospectively analyzing patients who underwent DMEK surgery.

Patients' demographics and surgical details were collected. Pre-PSR have been identified as stromal waves by performing an anterior segment optical coherence tomography (AS-OCT). The last preoperative and first postoperative available AS-OCT for each patient were analyzed for the presence of pre-PRS.

The difference in longitudinal trends of visual acuity recovery and final visual acuity after DMEK was identified in eyes with and without pre-PRS. Furthermore, the study investigated the frequency of rebubbling and the proportional relative risk of rebubbling in relation to the existence of both preoperative and postoperative posterior stromal ripples (PRS).

A total of 66 patients (71 eyes) were enrolled in the study. The presence of preoperative posterior stromal ripples (pre-PSR) was correlated with lower preoperative visual acuity (p = 0.02) and greater corneal thickness (p < 0.001). Eyes exhibiting pre-PSR achieved comparatively lower final visual acuity values than those without pre-PSR (p = 0.02). Cox proportional hazard ratios did not reveal a statistically significant difference in the relative risk of rebubbling associated with the presence of either preoperative or postoperative posterior stromal ripples (all p > 0.05).

The presence of pre-PSR is associated with morphological and permanent corneal changes observed in the last stages of endothelial dysfunction. This correlation contributes to a delayed visual recovery and potentially leads to a compromised postoperative best-corrected visual acuity (BCVA). Preoperative posterior stromal ripples may have predictive value for postoperative visual outcomes.