Authors Abraham K. Sleem , MD Robert L. Schultze , MD Robert A. Eden, MD William Yang, MD

Comparison of Endothelial Comparison of Endothelial Keratoplasty (EK) Visual Keratoplasty (EK) Visual

Outcomes with OCT Outcomes with OCT Derived Corneal Thickness Derived Corneal Thickness

MeasurementsMeasurementsAuthorsAuthors

Abraham K. Sleem, MDAbraham K. Sleem, MD

Robert L. Schultze, MDRobert L. Schultze, MD

Robert A. Eden, MDRobert A. Eden, MD

William Yang, MDWilliam Yang, MD

Nadia Haqqie, BSNadia Haqqie, BS

No Financial Interest in Study Material

IntroductionIntroduction• The advent of Descemet’s Stripping with Automated The advent of Descemet’s Stripping with Automated

Endothelial Keratoplasty (DSAEK) has changed the Endothelial Keratoplasty (DSAEK) has changed the current approach to the treatment of endothelial current approach to the treatment of endothelial diseases. The advantages of this procedure include diseases. The advantages of this procedure include shorter recovery time, less chance of sight-threatening shorter recovery time, less chance of sight-threatening complications, improved structural integrity of the complications, improved structural integrity of the cornea, and less irregular astigmatism compared to cornea, and less irregular astigmatism compared to penetrating keratoplasty. While recent models and penetrating keratoplasty. While recent models and studies attempt to predict refractive outcomes based on studies attempt to predict refractive outcomes based on donor tissue properties, this study investigates the donor tissue properties, this study investigates the relationship of the host and donor thickness related to relationship of the host and donor thickness related to best corrected visual acuity outcome. best corrected visual acuity outcome.

PurposePurposeTo determine the impact of pre-operative To determine the impact of pre-operative corneal thickness, as well as, post-corneal thickness, as well as, post-operative donor, recipient, and overall operative donor, recipient, and overall corneal thickness on EK visual outcomes.corneal thickness on EK visual outcomes.

MethodsMethods

• 47 eyes without visually significant retinal 47 eyes without visually significant retinal or optic nerve pathology underwent or optic nerve pathology underwent DSAEK by one surgeon (RLS). DSAEK by one surgeon (RLS).

• Pre-operative corneal pachymetry was Pre-operative corneal pachymetry was measured by ultrasound. measured by ultrasound.

• Post-operative recipient, donor and overall Post-operative recipient, donor and overall corneal thickness were determined corneal thickness were determined utilizing the Visante OCT at one year. utilizing the Visante OCT at one year.

MethodsMethods

• Mean BSCVA of two groups stratified by Mean BSCVA of two groups stratified by donor thickness was compared using the donor thickness was compared using the student t-test. student t-test.

• Post-operative BSCVA was also Post-operative BSCVA was also correlated with each measured thickness correlated with each measured thickness utilizing regression analysis. utilizing regression analysis.

Surgical TechniqueSurgical Technique• DSAEK donor buttons prepared with 300 DSAEK donor buttons prepared with 300

head on Moria ALTK systemhead on Moria ALTK system

• All Donors punched to 8mmAll Donors punched to 8mm

• Donor buttons inserted through 5 mm Donor buttons inserted through 5 mm woundwound

• Cornea massage and venting performedCornea massage and venting performed

• Air bubble maintained for one hour then Air bubble maintained for one hour then burpedburped

Parameter Average

Pre-Op Pachymetry 709.9±82.9µm

Post-Op BSCVA 20/35

Post-Op Recipient Bed Thickness

517.6±44.6µm

Post-Op Donor ThicknessPost-Op Donor Thickness 162.7±38.9µm162.7±38.9µm

Post-Op Total Thickness 680.3±63.4µm

Results: Data CollectedResults: Data Collected

Results: Statistical AnalysisResults: Statistical Analysis• No correlation between pre-operative pachymetry and No correlation between pre-operative pachymetry and

BSCVA (p>0.05)BSCVA (p>0.05)

• No correlation between host recipient bed thickness and No correlation between host recipient bed thickness and BSCVA (p>0.05)BSCVA (p>0.05)

• The average post-operative BSCVA was 20/33 and The average post-operative BSCVA was 20/33 and 20/36 for eyes with donor thickness <162µm and 20/36 for eyes with donor thickness <162µm and ≥162µm, respectively (p<0.04). ≥162µm, respectively (p<0.04).

• No linear correlation between donor thickness and No linear correlation between donor thickness and BSCVA BSCVA (p>0.05)(p>0.05)

Results:Results:BSCVA vs Donor Thickness BSCVA vs Donor Thickness

Results: Regression AnalysisResults: Regression AnalysisNo Linear Correlation between BSCVA and Donor Thickness

• Although the group of eyes that received Although the group of eyes that received thinner donors (<162µm) demonstrated thinner donors (<162µm) demonstrated statistically significant better post-statistically significant better post-operative vision on average, the difference operative vision on average, the difference was very small.was very small.

• No linear relationship between BSCVA No linear relationship between BSCVA and donor thickness was demonstrated and donor thickness was demonstrated with regression analysis.with regression analysis.

Conclusions

DiscussionDiscussion

• No clear linear relationship between post-No clear linear relationship between post-operative BSCVA and donor thickness operative BSCVA and donor thickness was demonstrated, however the group of was demonstrated, however the group of eyes with the thinner grafts showed only eyes with the thinner grafts showed only slightly better vision. slightly better vision.

• This may suggest that techniques that This may suggest that techniques that involve thinner grafts (ex. DMEK) may not involve thinner grafts (ex. DMEK) may not necessarily result in better BSCVA.necessarily result in better BSCVA.