Abstract
Purpose To assess the time course changes in corneal topographic parameters during the one-year follow-up after Descemet membrane endothelial keratoplasty (DMEK) surgery. Materials and Methods Twenty-one patients (24 eyes) who underwent DMEK surgery were evaluated. Best corrected visual acuity (BCVA), endothelial cell count (ECC), central corneal thickness (CCT), mean keratometry (MK), mean astigmatism (MA), astigmatism asymmetry (AA), and higher-order aberration (HOA) were assessed at baseline and 1, 3, 6 and 12 months after the surgery using CASIA2 anterior segment swept-source OCT (Tomey, Japan). Results In patients who underwent DMEK surgery, BCVA improved gradually at the subsequent visits during the 12-month follow-up. A significant reduction in ECC and CCT at the 1st month was noted, which remained stable until the 6th month postoperatively. Anterior and total MK values remained unchanged, whereas changes in posterior keratometry were noticeable until the 6th month after surgery. A significant reduction in the anterior, posterior, and total astigmatism magnitude as well as astigmatism asymmetry was observed during the first 6 months after surgery. A gradual anterior, posterior, and total HOA decrease was documented until the 12th month after surgery. Negative correlations between baseline values of CCT, MK, MA, AA, and HOA and postoperative variations in those parameters at consecutive follow-up time points were observed. Accordingly, negative correlations between baseline CCT and postoperative changes in corneal topographic parameters after surgery were found. Conclusion The stabilization of most corneal topographic parameters takes place within 6 months after the procedure, whereas HOA reduction and BCVA improvement gradually occur during the first year after surgery. Preoperative values of corneal topographic parameters strongly determine their changes detected after DMEK surgery, which may suggest that early therapeutic intervention results in better visual outcomes.
Highlights
In the last few years, Fuchs corneal endothelial dystrophy and pseudophakic bullous keratopathy have become the most common indications for corneal transplantation [1]
We found that preoperative central corneal thickness (CCT) negatively correlated with changes in corneal thickness, astigmatism power, astigmatism asymmetry, and higher-order aberration (HOA) at the following postoperative visits. is result indicates that the thicker the cornea before surgery, the lower the decrease in magnitudes of regular and irregular corneal astigmatism and HOA after Descemet membrane endothelial keratoplasty (DMEK) surgery
Is retrospective study provided such detailed analysis of the relationships between the dynamic status of corneal topographic parameters, corneal thickness, best corrected visual acuity, and endothelial cell count analyzed at several postoperative follow-up points throughout a 1-year observation period
Summary
In the last few years, Fuchs corneal endothelial dystrophy and pseudophakic bullous keratopathy have become the most common indications for corneal transplantation [1]. Less than 25 years ago, the introduction of endothelial keratoplasty (EK) by Melles in 1998 revolutionized corneal transplantation [2] and was a salvation for patients with corneal endothelial disease. E introduction of the Descemet membrane endothelial keratoplasty (DMEK). Technique, a selective replacement of the Descemet membrane and its endothelium, has resulted in significant progress in lamellar corneal surgery [3, 4]. Following the first procedures performed in 2006, the popularity of DMEK surgery quickly began to grow. DMEK, next to the other lamellar keratoplasty techniques as Descemet stripping endothelial keratoplasty (DSEK) or Descemet stripping automated endothelial keratoplasty (DSAEK), began to replace the conventional penetrating keratoplasty (PKP) for selective replacement of the diseased posterior layers of the Journal of Ophthalmology cornea in patients with endothelial insufficiency [5]. There was no need for expensive and specialized equipment, such as a microkeratome or femtosecond laser, for the preparation of the donor tissue while conducting DMEK surgery [9]
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