Thinner DSAEK grafts associated with greater vision improvement

This retrospective study of the effects of graft thickness and asymmetry on visual gain and higher-order aberrations (HOAs) after Descemet stripping automated endothelial keratoplasty (DSAEK) found that thinner grafts were associated with greater visual gain six months after surgery in patients without concurrent vision-limiting disease. This relationship was stronger in patients undergoing DSAEK for pseudophakic bullous keratopathy despite worse preoperative and postoperative visual acuity compared with patients who underwent DSAEK for Fuchs endothelial dystrophy.

Thicker grafts were associated with greater asymmetry of the posterior corneal surface, which in turn was associated with more posterior corneal HOAs. However, neither was correlated with visual gain. The analysis included 79 eyes of 71 patients. Mean BCVA improved from 0.63 logMAR to 0.25 logMAR six months postoperatively (P< 0.001).

After excluding patients with vision-limiting comorbidities, visual gain was significantly correlated with graft thickness, with this correlation strongest in patients with pseudophakic bullous keratopathy. Graft thickness significantly correlated with graft asymmetry in the 4- and 6-mm zones, which in turn correlated with all but spherical posterior HOAs.