Morten Brok Molbech Madsen

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.

Aims: To investigate corneal higher order aberrations (HOAs), densitometry and whole-eye optical quality after ultrathin Descemet’s stripping automated endothelial keratoplasty (UT-DSAEK), Descemet’s membrane endothelial keratoplasty (DMEK) and cataract surgery and the association with visual function. Methods: This predefined secondary analysis of a randomised trial included 72 patients with Fuchs’ endothelial dystrophy (FED) and cataract for UT-DSAEK or DMEK combined with cataract surgery. Thirty-seven patients with cataract and healthy corneas served as controls and underwent cataract surgery alone. Results: Total posterior HOAs were significantly higher 12 months after UT-DSAEK than DMEK (p2 =0.55, p2 =0.37, p<0.001). Conclusions: Total posterior HOAs and OSI were higher 12 months after UT-DSAEK than after DMEK and higher after DMEK than after cataract surgery alone. Visual acuity and contrast sensitivity were correlated with OSI. Although DMEK surgery for FED provides excellent visual rehabilitation, the corneal optical quality remains suboptimal. Trial registration number: NCT04417959 .

Purpose: To investigate circumpapillary retinal nerve fibre layer (RNFL) thickness, pupillary function and diameter after phacoemulsification and lens implantation alone or combined with endothelial keratoplasty (EK). Methods: This study was a secondary analysis of data from a randomized, single‐masked trial, that included 72 patients with Fuchs' endothelial dystrophy and cataract, equally allocated (1:1) to ultrathin Descemet's stripping automated endothelial keratoplasty or Descemet's membrane endothelial keratoplasty. The cataract extraction (CE) group included 40 patients undergoing cataract surgery only. All patients were treated with phacoemulsification and lens implantation. Results: RNFL thickness was significantly lower in the CE group than after EK for the global ( p < 0.01), nasal ( p = 0.04), and temporal sectors ( p = 0.01) 12 months after surgery. RNFL thickness was comparable between patients treated with rebubbling and others ( p ≥ 0.16 for all comparisons) after 12 months. The CE group and patients treated with EK demonstrated a comparable scotopic ( p = 0.34) and photopic pupil diameter ( p = 0.95) as well as a comparable maximum ( p = 0.83) and average pupillary constriction velocity ( p = 0.95) after 12 months. In contrast, patients treated with rebubbling had a significantly smaller scotopic pupil diameter ( p = 0.04). Conclusion: In this study, no evidence was found indicating a negative impact on the RNFL thickness after EK when compared to CE 12 months after surgery. Iris function and pupil diameter were comparable between the CE group and patients treated with EK after 12 months.

Aims: To compare best-corrected visual acuity (BCVA), contrast sensitivity and endothelial cell density (ECD) after ultrathin Descemet’s stripping automated endothelial keratoplasty (UT-DSAEK) and Descemet’s membrane endothelial keratoplasty (DMEK).Methods: A randomised, single-blinded, single-centre design was used. 72 patients with Fuchs’ endothelial dystrophy and cataract were randomised to UT-DSAEK or DMEK combined with phacoemulsification and lens implantation. 27 patients with cataract were included in a control group and treated with phacoemulsification and lens implantation. The primary outcome was BCVA at 12 months.Results: Compared with UT-DSAEK, DMEK resulted in better BCVA with mean differences of 6.1 early treatment diabetic retinopathy study (ETDRS) (p=0.001) after 3 months, 7.4 ETDRS (p2(p2(p2(p=0.03) after 12 months.Conclusions: Compared with UT-DSAEK, DMEK resulted in better BCVA 3, 6 and 12 months postoperatively. Twelve months postoperatively, DMEK had a higher ECD than UT-DSAEK; however, no difference in contrast sensitivity was found.Trial registration number: NCT04417959

Purpose: The aim was to investigate alterations in central retinal thickness (CRT) and their implications for visual acuity after ultrathin Descemet stripping automated endothelial keratoplasty (UT-DSAEK) and Descemet membrane endothelial keratoplasty (DMEK) combined with cataract surgery. Methods: A total of 72 eyes of 72 patients with Fuchs endothelial dystrophy and cataract were included and equally randomized to either UT-DSAEK or DMEK. A control group of 40 eyes of 40 patients with cataract were included for cataract surgery. All participants were examined preoperatively as well as 3 and 6 months postoperatively. Results: There was no significant difference in CRT between the study groups after surgery (P = 0.896). A significant difference in best-corrected visual acuity (BCVA) progression over time was found between the study groups (P < 0.0001). Average improvements of 8.03 EDTRS after UT-DSAEK (P < 0.001) and 16.77 EDTRS after DMEK (P < 0.001) were found 6 months postoperatively. No significant correlation was found between the change in BCVA and CRT from baseline to 3 months postoperatively (r² < 0.0001, P = 0.96) and from baseline to 6 months postoperatively (r² = 0.0053, P = 0.46). Conclusions: CRT was not altered by UT-DSAEK, DMEK, or cataract surgery 3 and 6 months postoperatively. BCVA significantly improved 3 and 6 months after UT-DSAEK and DMEK, respectively. No significant correlations were found between the change in BCVA and CRT postoperatively. As such CRT alterations were comparable after UT-DSAEK, DMEK, and cataract surgery.