Scattered light and visual acuity after Descemet‐stripping with endothelial keratoplasty

Abstract

Abstract Purpose The lamellar interface and anterior host cornea after posterior lamellar keratoplasty scatter more light than normal corneas. In this study, we examined the relationship between forward‐scattered light, back‐scattered light, and visual function after Descemet‐stripping with endothelial keratoplasty (DSEK). Methods Nineteen eyes of 17 patients received DSEK with the donor prepared by a microkeratome; all eyes were pseudophakic postoperatively. Eyes were examined before and at 6 months after surgery. Best‐corrected high‐contrast visual acuity (HCVA) was measured by electronic‐ETDRS and low‐contrast visual acuity (LCVA) was measured by using a 10% contrast chart. Intraocular forward light scatter was measured by using a stray‐light meter (Oculus C‐Quant) and back‐scattered light was measured in anterior, middle, and posterior thirds of the cornea by using a custom slit‐lamp scatterometer. Generalized estimating equation models were used for statistical analyses to account for possible correlation between fellow eyes of the same patient. Results HCVA improved from 0.46 ± 0.26 logMAR (20/58) before DSEK to 0.28 ± 0.15 logMAR (20/38) at 6 months (p<0.001, n=19), and LCVA improved from 0.88 ± 0.26 logMAR (20/152) before DSEK to 0.62 ± 0.19 logMAR (20/83) at 6 months (p<0.001). At 6 months after DSEK, forward light scatter correlated with HCVA (r=0.67, p<0.001) and with LCVA (r=0.75, p=0.006). Back‐scattered light from the anterior, mid, or posterior cornea were not correlated with forward scatter or with HCVA or LCVA (p>0.2). Conclusion Visual outcomes after DSEK are associated with the forward‐scattered light induced by the host cornea and lamellar interface, although not with the back‐scattered light visible on slit‐lamp examination.