Host and Graft Thickness after Descemet Stripping Endothelial Keratoplasty for Fuchs Endothelial Dystrophy

PURPOSE: To determine relationships between vision, forward scatter, and total corneal and graft thicknesses after Descemet stripping endothelial keratoplasty (DSEK). DESIGN: Prospective, cohort study. METHODS: Forty-four eyes with Fuchs endothelial dystrophy were examined before and at 1, 3, 6, and 12 months after DSEK; all eyes were pseudophakic after surgery. Central total corneal and graft thicknesses were measured using confocal microscopy. Best-corrected high-contrast visual acuity (BCVA) was measured using the electronic Early Treatment Diabetic Retinopathy Study protocol, and forward light scatter was measured using a straylight meter. RESULTS: Total corneal thickness was 610 +/- 50 vim (mean +/- standard deviation) before DSEK, increased to 680 +/- 74 mu m by 1 month after DSEK (P < .001), and stabilized at 660 +/- 68 mu m by 3 months after DSEK (P = .03 vs 1 month). Graft thickness was 170 +/- 57 mu m at 1 month, decreased to 157 +/- 49 mu m by 3 months (P = .004), and then remained stable through 12 months (156 +/- 51 mu m; P = .99 vs 3 months). BCVA was 0.44 +/- 0.21 logarithm of the minimal angle of resolution (logMAR) units (Snellen equivalent, 20/55) before DSEK, improved to 0.26 +/- 0.20 logMAR units (Snellen equivalent, 20/36) by 3 months (P < .001), and improved to 0.16 +/- 0.16 logMAR units (Snellen equivalent, 20/29) at 12 months (P < .001 vs 3 months). BCVA and forward light scatter did not correlate with corneal or graft thickness after DSEK. CONCLUSIONS: Stromal edema resolves by 3 months after DSEK for Fuchs dystrophy, whereas visual acuity continues to improve through 12 months. Thicker corneas and grafts are not associated with worse visual acuity or increased forward scatter. (Am J Ophthalmol 2010;150:490-497. (C) 2010 by Elsevier Inc. All rights reserved.)