Postoperative visual acuity in patients with fuchs dystrophy undergoing descemet membrane-stripping automated endothelial keratoplasty: correlation with the severity of histologic changes.

Heather Potter // Publications // Jan 01 2012

PubMed ID: 22232473

Author(s): Happ DM, Lewis DA, Eng KH, Potter HD, Neekhra A, Croasdale CR, Hardten DR, Nehls S, Eide M, Rowe J, Khedr S, Albert DM. Postoperative visual acuity in patients with fuchs dystrophy undergoing descemet membrane-stripping automated endothelial keratoplasty: correlation with the severity of histologic changes. Arch Ophthalmol. 2012 Jan;130(1):33-8. doi: 10.1001/archophthalmol.2011.375. Erratum in: Arch Ophthalmol. 2012 Mar;130(3):341. Arch Ophthalmol. 2012 May 1;130(5):654. Potter, Heather A D [corrected to Potter, Heather D]. PMID 22232473

Journal: Archives Of Ophthalmology (Chicago, Ill. : 1960), Volume 130, Issue 1, Jan 2012

OBJECTIVE To investigate a correlation between the severity of histologic changes of the Descemet membrane in patients with Fuchs endothelial dystrophy and the best-corrected visual acuity (VA) after Descemet membrane-stripping automated endothelial keratoplasty (DSAEK).

METHODS In a retrospective study design, we created a histologic grading system based on common characteristics observed histologically among 92 DSAEK specimens sent to the University of Wisconsin Eye Pathology Laboratory with a clinical diagnosis of Fuchs dystrophy from 3 separate corneal surgeons. Cases were graded as mild, moderate, or severe on the basis of guttae dispersion, presence of a laminated Descemet membrane, presence of embedded guttae, and density of guttae. Regression models were built to study the relationship among preoperative VA, histologic findings, and best-corrected VA 6 months and 1 and 2 years after DSAEK.

RESULTS No correlation was found between the severity of histologic changes of Descemet membrane and preoperative VA. However, a correlation was noted between the preoperative and final VA. Cases with a laminated Descemet membrane but no embedded guttae (n = 8) appeared to be less responsive to DSAEK. Otherwise, the severity of histologic changes of Descemet membrane observed in patients with Fuchs corneal dystrophy after DSAEK did not show a statistically significant correlation with final VA.

CONCLUSIONS Our analysis fails to show an inverse relationship between the severity of histologic changes of the Descemet membrane and the best-corrected VA of at least 20/40 after DSAEK for Fuchs endothelial dystrophy. However, in a subset of patients with Fuchs dystrophy who develop a laminated Descemet membrane without embedded guttae, the visual recovery after DSAEK is less than expected. The laminated architecture of Descemet membrane without embedded guttae may facilitate separation between the membrane layers and, thus, incomplete removal of the recipient’s Descemet membrane during DSAEK, which may then limit the postoperative visual outcome.