Determinants of visual quality after endothelial keratoplasty

Bringing clarity to endothelial keratoplasty outcomes A review of the literature indicates that newer endothelial keratoplasty  techniques are getting closer to achieving visual acuity of 20/20 in the majority of patients, but there may be a ceiling effect. The review’s authors note that the rates of use for endothelial keratoplasty as opposed to penetrating keratoplasty have increased dramatically over the past decade. Its advantages over PKP include superior biomechanical integrity, faster visual recovery with better uncorrected visual acuity, and a more predictable refractive outcome with less induced astigmatism . However, head-to-head comparisons of PKP and EK have failed to demonstrate statistically significant differences in final best-corrected BCVA outcomes. On the other hand, they note modern iterations, such as ultrathin Descemet’s stripping automated endothelial keratoplasty (DSAEK) and Descemet’s membrane endothelial keratoplasty (DMEK)  can achieve  comparable results to routine cataract surgery in terms of BCVA. The authors explore the many factors that may continue to limit visual outcomes following endothelial keratoplasty, including graft folds, interface interactions between host and graft tissue, higher order aberrations and disease effects in the host cornea.