Department of Ophthalmology (Guru Nanak Eye Centre) (R.A., P.G., J.S., P.J., S.V.), Maulana Azad Medical College, New Delhi, India; and Cornea and Refractive Services (R.S.), Shroff Eye Centre, New Delhi, India.
Eye Contact Lens. 2022 Jun 1;48(6):242-249. doi: 10.1097/ICL.0000000000000868. Epub 2021 Nov 25.
To assess the role of corneal densitometry and wavefront aberrations post Descemet stripping automated endothelial keratoplasty (DSAEK) and their correlation with visual acuity.
Twenty-seven eyes of 25 patients with nonresolving corneal edema for more than 3 months as a result of Fuchs endothelial corneal dystrophy, pseudophakic bullous keratopathy, or secondary endothelial dysfunction were enrolled in a prospective interventional study and underwent DSAEK. Postoperative evaluation for corneal aberrations, including Higher order aberrations (HOAs) and corneal densitometry (CD), was performed using anterior-segment optical coherence tomography (Avanti RTvue XR; Optovue) and Scheimpflug imaging (Pentacam, Oculus Optikgeräte GmbH, Wetzlar, Germany) at 6 months. A correlation analysis of corneal aberrations, including HOAs and CD, with postoperative best-corrected visual acuity at 6 months was performed.
Mean best-corrected visual acuity (BCVA) improved from 1.67±0.53 log of minimum angle of resolution (logMAR) to 0.2±0.22 logMAR post DSAEK at 6 months (P≤0.0001). At 6 months, mean root-mean-square (RMS) total corneal aberrations (includes HOA and low-order aberration [LOA]), RMS total HOA, and RMS LOA of the central 6-mm zone were 4.99±2.64, 1.80±0.9, and 4.55±2.64, respectively. The mean corneal densitometry from anterior, central, and posterior zones were 39.12±12.77, 23.9±7.2, and 13.54±2.04 gray scale units, respectively. Total anterior aberrations (r=0.051; P=0.006), anterior LOA (r=0.049; P=0.009), total corneal aberrations (r=0.051; P=0.001), total HOAs (r=0.095; P=0.057) and LOAs (r=0.050; P=0.002), and total CD from 0 to 2 mm (r=0.010; P=0.038) and 2 to 6 mm (r=0.014; P=0.018) showed a significant inverse correlation with postoperative BCVA.
There was an inverse relationship between post DSAEK BCVA and total corneal HOAs and full-thickness densitometry at 6 months. Scheimpflug imaging with added tools for corneal aberration and densitometry analysis gives further insight into the suboptimal vision achieved despite transparent corneas post DSAEK.
评估去表皮内皮角膜移植术后（DSAEK）角膜密度和波前像差的作用及其与视力的相关性。
25 例（27 只眼）因 Fuchs 内皮角膜营养不良、假性大泡性角膜病变或继发性内皮功能障碍导致角膜水肿超过 3 个月且无法消退的患者，前瞻性地进行了 DSAEK 手术。术后 6 个月，采用前节光学相干断层扫描（Avanti RTvue XR；Optovue）和 Scheimpflug 成像（Pentacam，Oculus Optikgeräte GmbH，德国威茨拉尔）对角膜像差（高阶像差和角膜密度）进行评估。分析术后 6 个月最佳矫正视力（BCVA）与角膜像差（包括高阶像差和角膜密度）的相关性。
术后 6 个月 BCVA 从 1.67±0.53 最小分辨角对数（logMAR）提高到 0.2±0.22 logMAR（P≤0.0001）。术后 6 个月，角膜总像差（包含高阶像差和低阶像差）、角膜总高阶像差和中央 6mm 区总低阶像差的均方根（RMS）值分别为 4.99±2.64、1.80±0.9 和 4.55±2.64。角膜前、中、后区的平均角膜密度分别为 39.12±12.77、23.9±7.2 和 13.54±2.04 灰度单位。总前向像差（r=0.051；P=0.006）、前向低阶像差（r=0.049；P=0.009）、角膜总像差（r=0.051；P=0.001）、角膜总高阶像差（r=0.095；P=0.057）和总低阶像差（r=0.050；P=0.002）以及角膜总密度（从 0 到 2mm，r=0.010；P=0.038）和 2 到 6mm，r=0.014；P=0.018）与术后 BCVA 呈显著负相关。
术后 6 个月，BCVA 与 DSAEK 术后角膜总高阶像差和全厚度密度呈负相关。Scheimpflug 成像结合角膜像差和密度分析的附加工具，可以进一步深入了解尽管 DSAEK 术后角膜透明，但视力仍不理想的原因。
