Optical quality after ultrathin Descemet's stripping automated endothelial keratoplasty and Descemet's membrane endothelial keratoplasty: a randomised controlled clinical trial.

Abstract

To investigate corneal higher order aberrations (HOAs), densitometry and whole-eye optical quality after ultrathin Descemet's stripping automated endothelial keratoplasty (UT-DSAEK), Descemet's membrane endothelial keratoplasty (DMEK) and cataract surgery and the association with visual function. This predefined secondary analysis of a randomised trial included 72 patients with Fuchs' endothelial dystrophy (FED) and cataract for UT-DSAEK or DMEK combined with cataract surgery. Thirty-seven patients with cataract and healthy corneas served as controls and underwent cataract surgery alone. Total posterior HOAs were significantly higher 12 months after UT-DSAEK than DMEK (p<0.001) and higher after DMEK than in the control group (p<0.01).Total densitometry for the central (0-2 mm) and peripheral (2-6 mm) annular corneal zones was significantly higher 12 months after UT-DSAEK than DMEK (p<0.01 for both comparisons).Objective scatter index (OSI) was significantly higher 12 months after UT-DSAEK than DMEK (p<0.01) and higher after DMEK than in the control group (p<0.001). For patients treated with endothelial keratoplasty, visual acuity and OSI were significantly correlated (r²=0.55, p<0.001), as were contrast sensitivity and OSI (r²=0.37, p<0.001). Total posterior HOAs and OSI were higher 12 months after UT-DSAEK than after DMEK and higher after DMEK than after cataract surgery alone. Visual acuity and contrast sensitivity were correlated with OSI. Although DMEK surgery for FED provides excellent visual rehabilitation, the corneal optical quality remains suboptimal. NCT04417959.