Influence of graft thickness and regularity on vision recovery after endothelial keratoplasty

AimTo assess the influence of graft thickness and regularity on visual recovery and postoperative wavefront aberrations after endothelial keratoplasty (EK).Methods150 EKs performed in eyes with corneal endothelial disorders and no other ocular comorbidities, preoperative and postoperative assessment with spectral domain optical coherence tomography and postoperative assessment with whole eye wavefront aberrometry were retrospectively analysed. Eyes were classified into five groups: Descemet Membrane Endothelial Keratoplasty (DMEK), nanothin Descemet Stripping Automated Endothelial Keratoplasty (DSAEK) (15–49 µm), ultrathin DSAEK (50–99 µm), thin DSAEK (100–149 µm) and conventional DSAEK (150–250 µm).ResultsThe preoperative diagnosis was Fuchs dystrophy in 139 eyes (92.7%). The graft thickness measured after graft deswelling was in average 74 µm with a mean coefficient of variation of 17%. The average follow-up time was 32 months. The mean spectacle-corrected logarithm of minimum angle of resolution visual acuity improved from 0.76 (20/116) before surgery to 0.14 (20/27) at last follow-up visit. No significant differences in final visual acuity were found between the five groups. The time to reach 20/40 vision was significantly shorter in the DMEK and nanothin DSAEK groups compared with the remaining three DSAEK groups. No significant differences in postoperative aberrometry measurements were found between the five groups. Shorter time to reach 20/40 visual acuity was associated with better preoperative visual acuity and thinner graft. Higher final vision improvement was associated with poorer preoperative visual acuity. Higher postoperative high-order aberrations were associated with poorer preoperative visual acuity.ConclusionThe main advantage of DMEK and nanothin DSAEK over thicker DSAEKs was the rapidity of visual recovery. Final quality of vision was not influenced by graft thickness and regularity.

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Visual Outcome of Combined Descemet Stripping Endothelial Keratoplasty and Sutured Scleral Fixated Intraocular Lens in Endothelial Decompensation with Coexistent Aphakia or Intra Ocular Lens Subluxation

Annals of the National Academy of Medical Sciences (India) ◽

10.1055/s-0041-1739036 ◽

2021 ◽

Author(s):

Jaya Kaushik ◽

Ankita Singh ◽

Rakesh Shetty ◽

Jitendra Kumar Singh Parihar ◽

Divya Kochhar ◽

...

Keyword(s):

Visual Acuity ◽

Visual Outcome ◽

Bullous Keratopathy ◽

Endothelial Keratoplasty ◽

Ocular Lens ◽

Descemet Stripping Endothelial Keratoplasty ◽

Lens Subluxation ◽

Preoperative Visual Acuity ◽

Endothelial Decompensation

Abstract Purpose To elucidate visual outcome of patients after combined Descemet stripping endothelial keratoplasty (DSEK) with scleral fixated intra ocular lens (SFIOL) implantation in patients of endothelial decompensation with coexistent aphakia or lens subluxation. Materials and Methods A prospective interventional study of combined DSEK with sutured SFIOL in the patients who have undergone surgery at our center over 6-month follow-up period. Preoperative visual acuity and slit lamp findings were documented. Postoperative follow-up was done at days 1, 3, and 7 subsequently, months 1 and 3, and thereafter monthly till the sixth month. Results Mean age of the patients was 60.47 years. Six patients had aphakic bullous keratopathy, while 11 patients had pseudophakic bullous keratopathy with subluxated posterior chamber IOL (PCIOL). Preoperative visual acuity ranged from hand movements close to face (LogMar 2.4) with accurate projection of rays to 1/60 (LogMar 2) due to existing corneal edema and aphakia. Postoperatively uncorrected visual acuity at 6 months improved up to 6/36 (LogMar 0.8) in all cases. There was gradual improvement in corneal clarity and compactness during the follow-up. A good donor tissue endothelial count and an adequate IOP control were vital prognostic factors for the successful outcome. Conclusion This novel surgical merger reduces the complications of lenticule dislocation into vitreous and repeated surgeries and shows results akin to when performed in a staged manner.

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Factors Influencing Visual Outcome after Penetrating Keratoplasty Combined with Intraocular Lens Implantation

European Journal of Ophthalmology ◽

10.1177/112067210301300203 ◽

2003 ◽

Vol 13 (2) ◽

pp. 134-138 ◽

Cited By ~ 3

Author(s):

J.B. Jonas ◽

R.M. Rank ◽

W.M. Budde ◽

G. Sauder

Keyword(s):

Visual Acuity ◽

Intraocular Lens ◽

Penetrating Keratoplasty ◽

Visual Outcome ◽

Intraocular Lens Implantation ◽

Postoperative Visual Acuity ◽

Factors Influencing ◽

Lens Implantation ◽

Preoperative Visual Acuity

Purpose To establish which factors influence visual outcome after penetrating keratoplasty combined with intraocular lens implantation. Methods This retrospective noncomparative clinical interventional case series study included 135 consecutive patients (mean age 70.2 ± 13.6 years) who underwent central penetrating allogenic keratoplasty combined with intraocular lens (IOL) implantation, all operated by the same surgeon. There were 79 triple procedures, 33 keratoplasties combined with an exchange of IOL, and 23 penetrating keratoplasties combined with a secondary implantation of a posterior chamber lens. Mean follow-up was 28.3 ± 18.7 months (range 3.3–112 months). Reasons for keratoplasty were herpetic or traumatic corneal scars or defects (46), Fuchs corneal endothelial dystrophy (22), pseudophakic or aphakic bullous keratopathy (49), corneal endothelial decompensation due to other reasons (15), and keratoconus (3). Main outcome measures were postoperative visual acuity and gain in visual acuity. Results Mean postoperative visual acuity and mean gain in visual acuity were 0.33 ± 0.21 (median 0.30) and 0.25 ± 0.20 (median 0.20), respectively. Compared with the preoperative measurements, mean visual acuity increased in 129 patients (129/135, 95.6%). Factors influencing postoperative visual outcome and gain in visual acuity were preoperative visual acuity (p<0.005), reason for keratoplasty (p<0.005), and diameter of the graft (p = 0.046). Postoperative visual outcome was independent of age, sex, right or left eye, presence of diabetes mellitus, preoperative refractive error, length of follow-up, duration of surgery, and preoperative intraocular pressure. Conclusions The most important factors influencing visual outcome after central penetrating allogenic keratoplasty combined with IOL surgery are preoperative visual acuity, graft size, and reason for keratoplasty. Other factors such as age, sex, diabetes mellitus, and preoperative refractive error do not substantially influence postoperative visual outcome.

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Graft thickness and visual acuity after automated endothelial keratoplasty

Acta Ophthalmologica ◽

10.1111/j.1755-3768.2012.t100.x ◽

2012 ◽

Vol 90 ◽

pp. 0-0

Author(s):

A RABOT ◽

V SOLER ◽

P FOURNIE

Keyword(s):

Visual Acuity ◽

Endothelial Keratoplasty ◽

Graft Thickness

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Keratoconic Bi-aspheric Contact Lenses

International Journal of Keratoconus and Ectatic Corneal Diseases ◽

10.5005/jp-journals-10025-1134 ◽

2016 ◽

Vol 5 (3) ◽

pp. 132-138

Author(s):

Ariela Gordon-Shaag ◽

Philip Fine ◽

Liat Gantz ◽

Arige Gideon-Abousaid ◽

Gad Serero

Keyword(s):

Visual Acuity ◽

Contact Lenses ◽

Case Series ◽

Visual Stability ◽

Wavefront Aberrations ◽

Body Sensation ◽

Quality Of Vision ◽

Base Curve ◽

Aspheric Lenses

ABSTRACT Aim This observational clinical case series examined patients with keratoconus (KC) fit with keratoconic bi-aspheric (KBA) lenses to assess visual acuity (VA), wavefront aberrations, physiological fitting, subjective comfort, and manufacturer's fitting guidelines. Materials and methods Seven adult patients (11 eyes, four females, mean age: 34.15 ± 14.12) with nipple cones from the Hadassah Academic College contact lens clinic (Jerusalem, Israel) were fit with KBA lenses by modifying the initial base curve (BC) to obtain an acceptable physiological fit. The uncorrected and corrected distance (D) and near (N) Snellen VA and the ocular wavefront measurements, and responses to a self-administered five-point scale questionnaire were compared after 2 weeks of wear using paired two-tailed t-test or Mann-Whitney U test, as appropriate. Results Visual acuity and total root mean square (RMS) improved significantly with the lenses (DVAuncorrected = 0.04 ± 0.02, DVAcorrected = 0.66 ± 0. 22, NVAuncorrected = 0.34 ± 0.30, NVAcorrected = 0.95 ± 0.12). Subjects reported an average of 7.0 ± 2.7 hours of wear daily, with good scores in visual stability, satisfaction with VA and quality of vision, improvement of mood and quality of life, and low scores in foreign body sensation, pain, red eye, and itching during wear, and difficulty with lens removal. An average of two BC modifications from the diagnostic lens were necessary (0.16 mm steeper in nine eyes, 0.27 mm flatter in two eyes). Conclusion Keratoconic bi-aspheric lenses can provide 7 hours of comfortable wear, significantly improved VA and total RMS aberrations, alongside subjective satisfaction. Base curve modifications can be reduced by fitting a diagnostic lens 0.75 mm steeper than the flattest keratometry reading. How to cite this article Gantz L, Gordon-Shaag A, Gideon-Abousaid A, Serero G, Fine P. Keratoconic Bi-aspheric Contact Lenses. Int J Kerat Ect Cor Dis 2016;5(3):132-138.

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Impact of graft thickness on visual acuity after Descemet's stripping endothelial keratoplasty

British Journal of Ophthalmology ◽

10.1136/bjophthalmol-2011-300462 ◽

2011 ◽

Vol 96 (2) ◽

pp. 246-249 ◽

Cited By ~ 40

Author(s):

Anthony J Shinton ◽

Michael Tsatsos ◽

Aris Konstantopoulos ◽

Srini Goverdhan ◽

Ahmad F Elsahn ◽

...

Keyword(s):

Visual Acuity ◽

Endothelial Keratoplasty ◽

Descemet’S Stripping Endothelial Keratoplasty ◽

Graft Thickness

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Does Preoperative or Postoperative Graft Thickness Influence Postoperative Visual Acuity in Descemet Stripping Automated Endothelial Keratoplasty for Advanced Pseudophakic Bullous Keratopathy?

Cornea ◽

10.1097/ico.0000000000002111 ◽

2019 ◽

Vol 38 (11) ◽

pp. 1358-1363

Author(s):

Jean-Marc Perone ◽

Pauline Rolland Le Moal ◽

Maxime Sot ◽

Florian Bloch ◽

Alireza Maleki ◽

...

Keyword(s):

Visual Acuity ◽

Bullous Keratopathy ◽

Endothelial Keratoplasty ◽

Postoperative Visual Acuity ◽

Pseudophakic Bullous Keratopathy ◽

Graft Thickness

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Correlation of Straylight and Visual Acuity in Long-Term Follow-up of Manual Descemet Stripping Endothelial Keratoplasty

Cornea ◽

10.1097/ico.0b013e31823f8ab7 ◽

2012 ◽

Vol 31 (4) ◽

pp. 380-386 ◽

Cited By ~ 17

Author(s):

Ivanka J. E. van der Meulen ◽

Tom C. T. van Riet ◽

Ruth Lapid-Gortzak ◽

Carla P. Nieuwendaal ◽

Thomas J. T. P. van den Berg

Keyword(s):

Visual Acuity ◽

Endothelial Keratoplasty ◽

Descemet Stripping Endothelial Keratoplasty ◽

Long Term Follow Up

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Descemet membrane endothelial keratoplasty: analysis of clinical outcomes of patients with 8–10 years follow-up

International Ophthalmology ◽

10.1007/s10792-021-02176-3 ◽

2022 ◽

Author(s):

Julia M. Weller ◽

Friedrich E. Kruse ◽

Theofilos Tourtas

Keyword(s):

Visual Acuity ◽

Endothelial Cell ◽

Clinical Outcomes ◽

Cell Density ◽

Corneal Thickness ◽

Endothelial Cell Density ◽

Endothelial Keratoplasty ◽

Descemet Membrane Endothelial Keratoplasty ◽

Descemet Membrane

Abstract Purpose This study aimed to evaluate the clinical outcomes up to 10 years after Descemet membrane endothelial keratoplasty (DMEK). Methods In this retrospective, consecutive, single-center case series the medical files of eyes which have received DMEK between 2009 and 2012 for the treatment of endothelial dysfunction was evaluated regarding follow-up time and clinical outcomes. Annual examinations of best-corrected visual acuity (BCVA), endothelial cell density (ECD), central corneal thickness (CCT) of 66 eyes which fulfilled the criterion of a minimum of 8 years follow-up were analyzed. Results BCVA improved from 0.55 ± 0.37 logMAR (n = 54) to 0.15 ± 0.11 (n = 47) in eyes without ocular comorbidities one year after DMEK (p < 0.001), and remained stable up to 10 years after DMEK. Mean ECD decreased to 744 ± 207 cells/mm2 (n = 39) after 9 years, and to 729 ± 167 cells/mm2 (n = 21) after 10 years, respectively. CCT decreased from 650 ± 67 μm before DMEK to 525 ± 40 μm (n = 56) after 1 year, increasing slowly to 563 ± 40 µm (n = 39) after 9 years, and to 570 ± 42 µm (n = 21) after 10 years, respectively. Graft failure occurred in 4 of 66 eyes after year 8. These 4 eyes required repeat DMEK after 101–127 months. Conclusion This study shows the long-term outcomes in a small subset of DMEK grafts. Visual acuity remained stable in spite of slowly increasing corneal thickness and diminishing endothelial cell density during the 10-year period after DMEK.

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