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

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.