Visual Outcomes following Descemet Stripping Automated Endothelial Keratoplasty for Corneal Endothelial Dysfunction

Abstract

Objective To assess objective and subjective visual outcomes achieved by patients with corneal endothelial dysfunction who have undergone surgical treatment with Descemet stripping automated endothelial keratoplasty (DSAEK). Methods A total of 40 eyes of 36 patients with corneal endothelial dysfunction underwent DSAEK. All were followed up for 1 year. Visual acuity (VA; logMAR), mean endothelial cell density (MCD; via noncontact specular microscopy), and topography assessment were performed at baseline (preoperatively). Visual acuity and topography measurement were repeated at postoperative year 1. Subjective assessment of visual quality was evaluated using the National Eye Institute Visual Function Questionnaire (NEI-VFQ). Results Preoperative best-corrected VA (BCVA) was 1.29 ± 0.53 logMAR with mean optical correction of -0.33 ± 1.74 D. Postoperative BCVA, assessed after a mean of 10.8 ± 2.1 months, showed mean line gain of 7.11 ± 4.8 logMAR, with optical correction of +1.17 ± 1.54 D. Mean 6-month postoperative pachymetry was 598.2 ± 72.3 µm. Three patients experienced premature graft detachment, requiring repositioning via injection of a sterile air bubble. No other adverse events were observed. Significant improvement (p<.05 for all) in general, near, and far vision, ocular pain, difficulty in carrying out daily tasks, dependency, social life, and mental health were reflected by NEI-VFQ scores at 10.4 ± 2.1 months postoperatively versus preoperatively. No significant correlation was noted between postoperative VA line gain and NEI-VFQ-25 questionnaire score (p>0.05). Conclusions Descemet stripping automated endothelial keratoplasty treatment may restore corneal clarity, improve VA, and increase vision-related quality of life in patients with advanced endothelial dysfunction. Further large-scale study is needed to corroborate these findings.