Influence of Early Descemet Stripping Endothelial Keratoplasty on Visual Outcomes in Pseudophakic Corneal Edema

Abstract

Longstanding corneal edema can lead to anterior stromal scarring that may limit visual acuity following Descemet stripping endothelial keratoplasty (DSEK). The ideal time to perform DSEK to prevent permanent changes is unclear. Our aim is to determine whether earlier DSEK is associated with improved visual outcomes. Cohort study. Setting: Institutional. Total of 120 eyes of patients who underwent DSEK for corneal edema following cataract surgery (CE); 87% of eyes had a diagnosis of Fuchs dystrophy. Post-DSEK visual acuity was compared in patients who underwent DSEK ≤6months vs >6months after CE. Linear and logistic regression were performed to assessthe relationships between DSEK timing and best spectacle-corrected visual acuity (BSCVA) while accounting for baseline preoperative patient characteristics. Postoperative best-corrected visual acuity 6months after DSEK (POM6 BSCVA). Median CE-to-DSEK time was 8.62 (interquartile range [IQR] 12.28) months (n= 120). Overall median preoperative VA and POM6 BSCVA were 0.54 (IQR 0.68) and 0.24 (IQR 0.16), respectively. Median POM6 BSCVA was better in patients with CE-to-DSEK time ≤6months (median 0.18, IQR 0.19) vs >6months (median 0.30, IQR 0.21) (P= .014). A significant relationship was found between CE-to-DSEK time and POM6 BSCVA (coefficient= 0.002, P= .033), accounting for preoperative vision and pachymetry. Patients who underwent DSEK ≤6months after CE were more likely to achieve POM6 BSCVA better than 20/40 (odds ratio= 3.73 P= .035). Performing earlier DSEK for pseudophakic corneal edema appears to be associated with improved vision. Further prospective study is warranted to determine the optimal time to perform DSEK in patients with pseudophakic corneal edema.