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Anterior corneal higher-order aberrations persist after DSEK for Fuchs’ dystrophy
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Anterior corneal higher-order aberrations remained high for 2 years in patients with Fuchs’ endothelial dystrophy who underwent Descemet’s stripping endothelial keratoplasty, according to a study.
“The aberrated anterior surface might be related to anterior corneal ultrastructural changes and haze formation in Fuchs’ dystrophy and should not be ignored as a source of decreased visual acuity after DSEK,” the study authors said.
The prospective study included 27 eyes of 25 patients with a mean age of 67 years who underwent DSEK for Fuchs’ endothelial dystrophy and were followed up for 2 years. A comparator group comprised two subgroups of patients with healthy corneas: 37 phakic eyes of 26 patients with a mean age of 69 years and 15 pseudophakic eyes of nine patients with a mean age of 67 years.
Patients in the DSEK group underwent corneal topography, visual acuity assessment and biomicroscopy preoperatively and 1, 3, 6, 12 and 24 months postoperatively. Wavefront errors were extrapolated from corneal topography and denoted as Zernike polynomials up to the sixth order.
Patients in the control group underwent examination of corneal topography only.
Preoperative higher-order aberrations from the anterior corneal surface were 0.29 μm in the DSEK group and 0.17 μm in the control group; the difference was statistically significant (P < .001).
Total higher-order aberrations at 2 years in the DSEK group differed insignificantly from preoperative aberrations but were significantly higher than those in the control group (P < .001).
A strong correlation was observed between higher-order aberrations and best corrected visual acuity (P < .001), subepithelial haze (P = .01) and age (P < .001).
Central graft thickness did not correlate with total higher-order aberrations at 12 months or 24 months.
Perspective
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Marianne O. Price, PhD
This article suggests that early treatment of Fuchs’ dystrophy may benefit patients because anterior corneal aberrations are higher in Fuchs’ dystrophy patients than in controls and remain higher for at least 2 years after endothelial keratoplasty. Whereas some attribute decreased visual acuity relative to expected visual potential after DSEK primarily to the graft interface, this article highlights the importance and persistence of anterior corneal ultrastructural changes in Fuchs’ dystrophy. The authors did not report whether any of the DSEK eyes had the epithelium removed at the time of surgery; epithelial removal could have an effect on postoperative anterior corneal aberrations and haze.
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