Parámetros ópticos en ojos intervenidos de DSAEK

Abstract

ABSTRACT Fuchs endothelial dystrophy is a common progressive disease, characterized by progressive loss of endothelial cells and stromal edema. Descemet Stripping Automated Endothelial Keratoplasty (DSAEK) is the technique of choice for many surgeons to remove this disease. The technique is based on the selective replacement of diseased endothelium replaced by a healthy donor tissue. This technique has the advantage of a fast visual recovery. However, after the surgery, patients usually present increased light scattered by the cornea and optical degradation caused by increased ocular aberrations. The ocular aberrations are the primary determinant of image quality. Due to the change in the corneal shape associated with the addition of the lenticule donor in eyes with DSAEK surgery, it is not surprising that aberrations arising from the posterior surface are increased, although we must not forget that the anterior surface can be slightly different due to the long-term corneal disease. Such irregularity, with the resulting corneal scarring after surgery, can cause an increase in light scattering by the loss of transparency of the corneal anterior surface that even DSAEK surgery cannot solve. Therefore, the purpose of this study is to analyze the corneal diopter of patients diagnosed with Fuchs endothelial dystrophy that underwent DSAEK and compare to the corneas of a control group of patients undergoing cataract surgery. To make this, we analyzed 33 eyes of 24 patients, all diagnosed with Fuchs endothelial dystrophy and treated with DSAEK. They have conducted tests of visual acuity, subjective refraction, biomicroscopy, fundus examination, analysis of aberrations by Pentacam, corneal thickness measurement by Pentacam and OCT and evaluation of the intraocular Straylight measured by C-Quant. The results show that the maximum corrected visual acuity increases after surgery and a myopic change in the spherical equivalent is made, but this change is not significant. Ocular aberrations remain unchanged except for the posterior corneal surface. Corneal thickness values are significantly higher compared to the control group and the endothelial lenticule presents variation in thickness between the center and the periphery. Finally, intraocular Straylight is significantly higher compared to the control group, with a higher peak of densitometry in the anterior corneal surface measured by Pentacam. In light of the obtained results, DSAEK surgery is an effective treatment for Fuchs endothelial dystrophy, although several optical parameters do not return to normal after surgery.