The Effect Of Posterior Corneal Surface Abnormalities After Deep Anterior Lamellar Keratoplasty On Visual Outcomes And High Order Aberrations

To investigate the effect of various posterior corneal surface abnormalities following deep anterior lamellar keratoplasty (DALK) on visual outcomes and high order aberrations (HOA).

Alexandria Main University Hospital, Alexandria, Egypt. A retrospective cohort study

DALK cases were divided into two groups: Group A with posterior corneal surface abnormalities (interface haze, pre-Descemet’s scarring, central Descemet's membrane (DM) perforation, and central DM folds) and Group B (control group) with regular posterior surface. Visual acuity, refractive outcomes, contrast sensitivity, and HOA were assessed in both groups.

Each group included 42 eyes. Group A exhibited significantly lower corrected distance visual acuity (CDVA) compared to group B (Mean LogMAR 0.45 ± 0.25 vs 0.31 ± 0.21 respectively, P= 0.012). The mean topographic astigmatism was significantly higher in group A than in group B (4.47 ± 2.36 diopters vs 3.11 ± 2.16 diopters, respectively, P=0.001). No significant differences were found between the 2 groups regarding total eye or corneal HOA. Anterior corneal trefoil and secondary astigmatism were significantly higher in group A compared to group B (P= 0.010 and P= 0.005 respectively). Contrast sensitivity was significantly lower in Group A at lower spatial frequencies (P= 0.013 and P=0.004 at 3 and 6 cycles per degree, respectively).

Posterior corneal surface abnormalities after DALK can negatively impact visual outcomes, especially contrast sensitivity.