Purpose: 

To assess the role of corneal densitometry and wavefront aberrations post Descemet stripping automated endothelial keratoplasty (DSAEK) and their correlation with visual acuity.

Methods: 

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.

Results: 

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.

Conclusion: 

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.

中文翻译：

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后弹力层剥离后角膜 Scheimpflug 密度测定法和眼波前像差的分析自动内皮角膜移植术

目的： 

评估后弹力层剥离自动内皮角膜移植术 (DSAEK) 后角膜密度测定和波前像差的作用及其与视力的相关性。

方法： 

由于 Fuchs 角膜内皮营养不良、假晶状体大疱性角膜病或继发性内皮功能障碍，25 名角膜水肿持续超过 3 个月的患者的 27 只眼被纳入一项前瞻性介入研究并接受 DSAEK。使用前段光学相干断层扫描 (Avanti RTvue XR; Optovue) 和 Scheimpflug 成像 (Pentacam, Oculus Optikgeräte GmbH, Wetzlar, Germany) 对角膜像差进行术后评估，包括高阶像差 (HOA) 和角膜密度测定 (CD)在 6 个月时。进行了角膜像差（包括 HOA 和 CD）与术后 6 个月时最佳矫正视力的相关性分析。

结果： 

在 DSAEK 后 6 个月时，平均最佳矫正视力 (BCVA) 从最小分辨率角度 (logMAR) 的 1.67±0.53 logMAR 提高到 0.2±0.22 logMAR ( P ≤0.0001)。6 个月时，中央 6 毫米区域的平均均方根 (RMS) 总角膜像差（包括 HOA 和低阶像差 [LOA]）、RMS 总 HOA 和 RMS LOA 分别为 4.99±2.64、1.80±分别为 0.9 和 4.55±2.64。前区、中央区和后区的平均角膜光密度分别为 39.12±12.77、23.9±7.2 和 13.54±2.04 个灰度单位。总前部像差 (r=0.051; P =0.006)、前部 LOA (r=0.049; P =0.009)、总角膜像差 (r=0.051; P =0.001)、总 HOA (r=0.095; P =0.057) 和LOA (r=0.050;P = 0.002），0 至 2 毫米（r = 0.010；P = 0.038）和 2 至 6 毫米（r = 0.014；P = 0.018）的总 CD 与术后 BCVA 呈显着负相关。

结论： 

在 6 个月时，DSAEK 后 BCVA 与总角膜 HOA 和全层密度测定之间存在反比关系。Scheimpflug 成像添加了用于角膜像差和光密度分析的工具，可以进一步了解在 DSAEK 后角膜透明的情况下实现的次优视力。