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DSAEK grafts yield greater thickness, haze than PK

Cornea. 2011;30:287-290.

Issue: June 25, 2011

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Patients who underwent Descemet's stripping automated endothelial keratoplasty had increased corneal thickness and significantly more haze during follow-up than those who underwent penetrating keratoplasty, a study showed.

Using the Pentacam Scheimpflug system (Oculus), researchers analyzed 30 consecutive patients, of whom 18 underwent DSAEK and 12 underwent PK.

At 2-week, 1-month and 3-month follow-up, corneas in the DSAEK group were found to be significantly thicker than those in the PK group (P < .01). In addition, corneas in the DSEAK group showed significantly more haze compared with the PK group, but the haze was observed mainly in the subepithelial stroma.

The authors noted a possible disadvantage of using the Pentacam system to measure haze in that measurements depend on the light source.

"Although the stability of the Pentacam is guaranteed to be within 1% margin of error, haze values may be affected by the stability of individual devices," they said.

Additional research is needed to evaluate the relationship of haze to postoperative visual function, but treatments that reduce postoperative haze could be an option to improve corneal transparency after DSAEK, the authors said.

DSAEK has changed the indications for when to treat endothelial dysfunction. When PK was the only surgical option, it was common to postpone treatment for as long as possible due to risks like induced astigmatism and traumatic wound rupture, but with DSAEK, these risks are minimal. Furthermore, as demonstrated in this study, early treatment with DSAEK may prevent prolonged corneal decompensation, which causes anterior stromal changes and sub-epithelial haze. Unlike PK, DSAEK does not replace the recipient anterior stroma, and subepithelial haze may delay full visual recovery. Yet the cornea has amazing regenerative capacity and clearing does occur with time. Depending upon the extent of the stromal changes, superficial keratectomy, photorefractive keratectomy or phototherapeutic keratectomy may be used to remove anterior corneal scarring and accelerate visual recovery.

– Marianne O. Price, PhD
Executive Director, Cornea Research Foundation of America
Disclosure: Dr. Price has no relevant financial disclosures.