Anterior corneal surface irregularity after Descemet-stripping endothelial keratoplasty for bullous keratopathy

Purpose: To evaluate irregularity of the anterior cornea before and after Descemet stripping endothelial keratoplasty (DSEK) for bullous keratopathy and its effect on visual acuity. Methods: Corneal data were acquired using a topographic unit before and up to 12 months after DSEK. Anterior corneal elevation data were decomposed into a set of Zernike polynomials up to the 8th order within a 6.0-mm diameter region. Total higher-order aberrations (HOAs) and root mean square from the 3rd to 8th order were calculated. The effects of anterior surface irregularity on visual acuity were evaluated. Results: This clinical study comprised 20 consecutive eyes of 20 patients with bullous keratopathy. The mean corrected distance visual acuity (CDVA) was 1.00 +/- 0.12 logMAR (SD) preoperatively and 0.24 +/- 0.16 logMAR 12 months postoperatively. Before DSEK, corneas with bullous keratopathy had higher total HOAs compared with those in controls (p<0.05). There were no significant differences in anterior surface HOAs between preoperatively and 12 months (p>0.05). Conclusions: Postoperative CDVA correlated with irregularity of the corneal anterior surface. Corneal anterior HOAs are higher in patients with bullous keratopathy than in controls, and remain higher through 12 months after DSEK. In addition to corneal transparency, regularity of the corneal anterior surface is an important factor in visual acuity after DSEK.