Post-DSAEK vision in Fuchs’ endothelial dystrophy not related to severity of histologic changes

This retrospective study examined the relationship between the severity of histologic changes of Descemet's membrane in patients with Fuchs' endothelial dystrophy and their BCVA after DSAEK. The authors report that both postoperative and preoperative vision were not found to be related to histologic severity of disease. However, among a subgroup of cases that developed a laminated Descemet's membrane without embedded guttae, visual recovery after DSAEK was less than expected.

They examined 92 DSAEK specimens with a clinical diagnosis of Fuchs' dystrophy sent from three corneal surgeons to one university pathology laboratory. They graded cases as mild, moderate or severe on the basis of guttae dispersion, presence of a laminated Descemet's membrane, presence of embedded guttae and density of guttae. They built regression models to study the relationships between preoperative visual acuity, histologic findings and BCVA six months, one year and two years after DSAEK.

They failed to find a statistically significant correlation between the severity of histologic changes of Descemet's membrane and BCVA of at least 20/40 after DSAEK. They say it is possible that stromal changes are not permanent or do not correlate with the severity of pathologic changes observed in Descemet's membrane specimens.

Among the subgroup of eight cases with laminated Descemet's membrane without embedded guttae, postoperative vision improved by a fixed amount relative to preoperative vision. The authors speculate that the laminated architecture of Descemet's membrane without embedded guttae may facilitate separation between the membrane layers and, therefore, incomplete removal of Descemet's membrane during DSAEK, which may then limit postoperative visual outcome. They recommend further study of this histologic presentation since this result was rare and unexpected.