Corneal Higher-Order Aberrations in DMEK versus UT-DSAEK in DETECT: A Randomized Clinical Trial. Ophthalmology Duggan, M. J., Rose-Nussbaumer, J., Lin, C. C., Austin, A., Labadzinzki, P. C., Chamberlain, W. D. 2019


PURPOSE: To compare corneal higher-order aberrations (HOA) following ultrathin Descemet stripping automated endothelial keratoplasty (UT-DSAEK) and Descemet membrane endothelial keratoplasty (DMEK).DESIGN: Patient and outcome-masked, randomized controlled clinical trial.PARTICIPANTS: Patients with damaged or diseased endothelium from Fuchs endothelial dystrophy or pseudophakic bullous keratopathy who were considered good candidates for DMEK or UT-DSAEK.METHODS: Corneal anterior and posterior surface HOA were measured with Scheimpflug imaging before surgery and at 3, 6, and 12 months post-operatively. Zernike orders 3-8 were calculated at 4.0- and 6.0-mm-diameter optical zones (OZ). HOA after UT-DSAEK and DMEK were compared and correlation was performed between best spectacle-corrected visual acuity (BSCVA) and HOA at each time point.MAIN OUTCOME MEASURES: Higher-order aberrations of the anterior and posterior cornea, expressed as the root mean square deviation from a best fit sphere reference surface.RESULTS: At 3, 6, and 12 months after surgery, the posterior corneal surface had significantly less coma (P=0.003) and total HOA (P=0.001) in DMEK compared to UT-DSAEK (4.0- and 6.0-mm OZ). Posterior trefoil (P=0.034), secondary astigmatism (P=0.042), and tetrafoil (P=0.045) were lower in DMEK than UT-DSAEK at 3, 6, or 12 months (either 4.0- or 6.0-mm OZ). There were no significant differences in anterior surface HOA between DMEK and UT-DSAEK at any time point. Compared to baseline, total posterior HOA was significantly increased (P=0.036) in UT-DSAEK at 3, 6, and 12 months, in contrast to DMEK where it was significantly decreased (P=0.044) at 6 and 12 months (4.0- and/or 6.0-mm OZ). At 6 and 12 months, posterior corneal total HOA correlated moderately with BSCVA (rho=0.635, P=0.001) (4.0- and 6.0-mm OZ). There were no moderate or strong correlations between anterior or combined corneal surface HOA at any time point after surgery.CONCLUSIONS: DMEK results in less posterior corneal HOA compared to UT-DSAEK. DMEK decreases and UT-DSAEK increases posterior corneal HOA compared to pre-surgical values. Total posterior corneal HOA correlates moderately with 6- and 12-month post-operative visual acuity and may partially account for the better visual acuity observed after DMEK.

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