Fellow Eye Comparison of Tomographic Parameters and Higher-Order Aberrations in Ultrathin Descemet Stripping Automated Endothelial Keratoplasty and Descemet Membrane Endothelial Keratoplasty

Abstract

Purpose To assess the functional outcomes of ultrathin Descemet stripping automated endothelial keratoplasty (UT-DSAEK) and Descemet membrane endothelial keratoplasty (DMEK) for Fuchs endothelial corneal dystrophy in fellow eyes.

Methods Retrospective study of 28 eyes (14 patients) undergoing UT-DSAEK in one eye and DMEK in the fellow eye with a follow-up of at least one year. Main outcomes were best-corrected visual acuity (BCVA), central corneal thickness (CCT), endothelial cell density (ECD), and anterior and posterior tomographic parameters, including corneal higher-order aberrations (HOAs).

Results The UT-DSAEK and DMEK groups showed no differences in donor characteristics or preoperative corneal tomographic parameters. BCVA improved in both groups, but visual recovery was faster in the DMEK group. CCT and ECD decreased in the UT-DSAEK and DMEK groups, but without differences between the groups. Posterior mean keratometry and posterior Q-value increased in the UT-DSAEK and DMEK groups with higher values of both parameters in the UT-DSAEK group. As regards corneal aberrations, higher root mean-square values for HOAs of the posterior cornea and higher values of posterior Trefoil were evident in the UT-DSAEK group than in the DMEK group.

Conclusion Visual quality after endothelial keratoplasty might depend not on visual acuity alone, but also on corneal aberrations and asphericity of the anterior and posterior corneal surface. The results support the benefits of DMEK over UT-DSAEK, suggesting the need for long-term studies with a larger number of patients.

Zusammenfassung

Hintergrund Untersuchung der funktionellen Ergebnisse der „Ultrathin Descemet Stripping Automated Endothelial Keratoplasty“ (UT-DSAEK) und „Descemet Membrane Endothelial Keratoplasty“ (DMEK) bei Fuchsʼscher endothelialer Hornhautdystrophie in Partneraugen.

Methoden Retrospektive Studie von 28 Augen (14 Patienten), die an einem Auge mit UT-DSAEK und am anderen Auge mit DMEK behandelt wurden, mit einem Follow-up von mindestens 1 Jahr. Die Hauptzielgrößen waren die bestkorrigierte Sehschärfe (BCVA), die zentrale Hornhautdicke (CCT), die Endothelzelldichte (ECD) sowie anteriore und posteriore tomografische Parameter einschl. der Hornhautaberrationen höherer Ordnung (HOAs).

Ergebnisse Die UT-DSAEK- und DMEK-Gruppe wiesen keine Unterschiede bei den Spendermerkmalen oder den präoperativen tomografischen Hornhautparametern auf. Der Visus verbesserte sich in beiden Gruppen, jedoch war die visuelle Erholung in der DMEK-Gruppe schneller. CCT und ECD verringerten sich in der UT-DSAEK- und DMEK-Gruppe, jedoch ohne Unterschiede zwischen den Gruppen. Die posteriore mittlere Keratometrie und der posteriore Q-Wert stiegen in der UT-DSAEK- und der DMEK-Gruppe an, wobei beide Parameter in der UT-DSAEK-Gruppe signifikant höhere Werte aufwiesen. Hinsichtlich der Hornhautaberrationen zeigten sich in der UT-DSAEK-Gruppe im Vergleich zur DMEK-Gruppe höhere Werte der RMS-HOAs für die posteriore Hornhaut und höhere Werte für das posteriore Trefoil.

Schlussfolgerung Die Visusqualität nach einer endothelialen Keratoplastik hängt möglicherweise nicht nur von der Sehschärfe allein ab, sondern auch von den Hornhautaberrationen und der Asphärizität der Vorder- und Rückfläche. Die Ergebnisse sprechen für die Vorteile der DMEK gegenüber der UT-DSAEK und weisen auf die Notwendigkeit von Langzeitstudien mit einer größeren Anzahl von Patienten hin.

Conclusion Box

Already known:

• Descemet Membrane Endothelial Keratoplasty (DMEK) and Ultrathin Descemet Stripping Automated Endothelial Keratoplasty (UT-DSAEK) are established procedures for the treatment of endothelial corneal dystrophies.

• It was not sufficiently understood how both procedures affect higher order aberrations (HOAs) and asphericity.

Newly described:

• The results show that UT-DSAEK has a higher increase in posterior corneal aberrations (RMS HOAs and trefoil) than DMEK, indicating a lower optical quality with UT-DSAEK.

• The posterior curvature and asphericity parameters (Kmean, Q-value) are higher in UT-DSAEK than in DMEK, which might be explained by the presence of additional stroma.

Keywords

UT-DSAEK - DMEK - keratoplasty - higher-order aberrations - astigmatism - corneal transplantation

Schlüsselwörter

UT-DSAEK - DMEK - Keratoplastik - Hornhauttransplantation - Aberrationen höherer Ordnung - Astigmatismus

Publication History

Received: 10 July 2024

Accepted: 11 March 2025

Article published online:
23 April 2025

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