Purpose: 

It remains unclear whether preoperative central graft thickness (CGT) contributes to visual outcomes of Descemet stripping automated endothelial keratoplasty (DSAEK). This retrospective cohort study examined the ability of preoperative and postoperative CGT to predict 12-month best spectacle–corrected visual acuity (BSCVA) after DSAEK for Fuchs endothelial corneal dystrophy/moderate pseudophakic bullous keratopathy/second graft.

Methods: 

All consecutive patients who underwent DSAEK in 2015 to 2018 were included. The primary end point was 12-month BSCVA. DSAEK-CGT was measured preoperatively and 6 times between postoperative day 8 and month 12. Eyes were divided according to preoperative CGT 130 μm (ultrathin-DSAEK threshold) or 6-month postoperative CGT 100 μm (mean 6-month postoperative DSAEK-CGT). The t test assessed CGT evolution of the 4 groups over time. Multivariate analyses examined whether preoperative CGT or 6-month CGT categories predicted 12-month BSCVA. Multivariate analysis assessed the preoperative/perioperative factors that predicted 6-month CGT.

Results: 

A total of 108 eyes (68 patients) underwent DSAEK. Preoperative CGT was >130 and ≤130 μm in 87 and 21 eyes, respectively. Postoperative CGT was >100 and ≤100 μm in 50 and 58 eyes, respectively. Thin 6-month postoperative grafts thinned significantly more relative to preoperative thickness than thick grafts (P < 0.001). Preoperative CGT subgroups did not show this difference. Six-month postoperative CGT (P = 0.01), but not preoperative CGT, predicted 12-month BSCVA. Preoperative CGT strongly predicted 6-month CGT (P = 0.0003).

Conclusions: 

Postoperative, but not preoperative, DSAEK-CGT predicted 6-month BSCVA. The correlation between preoperative and postoperative CGT and interstudy variation in preoperative CGT measurement accuracy may explain literature disparities regarding the importance of preoperative CGT in DSAEK outcomes.

中文翻译：

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术后 6 个月的移植物厚度可预测针对 Fuchs 营养不良和中度晶状体眼大疱性角膜病的后弹力层剥离自动化内皮角膜移植术的长期视力结果：一项队列研究

目的： 

目前尚不清楚术前中央移植物厚度（CGT）是否有助于后弹力层剥离自动内皮角膜移植术（DSAEK）的视觉效果。这项回顾性队列研究检查了术前和术后 CGT 预测 Fuchs 内皮性角膜营养不良/中度人工晶状体大疱性角膜病变/第二次移植术后 DSAEK 后 12 个月最佳眼镜矫正视力 (BSCVA) 的能力。

方法： 

2015 年至 2018 年连续接受 DSAEK 的所有患者均纳入其中。主要终点是 12 个月的 BSCVA。术前测量 DSAEK-CGT，术后第 8 天至第 12 个月测量 6 次。根据术前 CGT 130 μm（超薄-DSAEK 阈值）或术后 6 个月 CGT 100 μm（平均术后 6 个月 DSAEK-CGT）划分眼睛。t检验评估了 4 组随时间的 CGT 演变。多变量分析检查了术前 CGT 或 6 个月 CGT 类别是否可以预测 12 个月 BSCVA。多变量分析评估了预测 6 个月 CGT 的术前/围手术期因素。

结果： 

共有 108 只眼睛（68 名患者）接受了 DSAEK。术前 CGT 分别为 87 眼和 21 眼>130 和≤130 μm。术后 CGT 分别为 50 眼和 58 眼>100 和≤100 μm。与术前厚度相比，术后 6 个月较薄的移植物比较厚的移植物显着变薄（P < 0.001）。术前 CGT 亚组没有显示出这种差异。术后 6 个月的 CGT（P = 0.01）而非术前的 CGT 可以预测 12 个月的 BSCVA。术前 CGT 强烈预测 6 个月 CGT ( P = 0.0003)。

结论： 

术后（而非术前）DSAEK-CGT 预测了 6 个月的 BSCVA。术前和术后 CGT 之间的相关性以及术前 CGT 测量准确性的研究间差异可以解释关于术前 CGT 在 DSAEK 结果中的重要性的文献差异。