Transplant Thickness and Asymmetry Related to Best-Corrected Visual Acuity After Ultra-Thin Descemet Stripping Automated Endothelial Keratoplasty

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Abstract
Purpose: To investigate how transplant thickness and transplant asymmetry may influence best-corrected visual acuity (BCVA) after ultra-thin Descemet stripping automated endothelial keratoplasty (UT-DSAEK) procedure by using data from a controlled trial investigating BCVA after UT-DSAEK. Methods: Participants with Fuchs endothelial dystrophy underwent UT-DSAEK with eye bank prepared grafts. Twelve months postoperatively, follow-up evaluations, including BCVA, were conducted. From Optical Coherence Tomography images of the prepared donor grafts, transplant thickness was measured centrally and 1, 2, 3, and 4 mm from the center in both directions along 4 meridians to assess the entire graft. Regression analyses were used to analyze the relation between BCVA and the 2 variables: thickness at the thinnest point of the transplant and transplant asymmetry estimated by the standard deviation of thickness variation. Results: Among 33 grafts implanted in 33 patients, the mean BCVA at 12 months was 80.4 early treatment diabetic retinopathy study letters. Mean thickness at the thinnest point was 74.1 μm (range: 32–114, SD = 22.6). Thickness at the thinnest point was significantly correlated with better BCVA at 12 months ( P = <0.001), whereas transplant asymmetry was not significantly correlated with BCVA. Conclusions: This study emphasizes that transplant thickness, particularly at the thinnest point, significantly affects BCVA after UT-DSAEK. Transplant asymmetry had no significant impact on BCVA. These findings underscore the critical role of minimizing transplant thickness in optimizing visual acuity even in patients undergoing UT-DSAEK.

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