LONDON — Anterior corneal aberrations, which develop as a consequence of Fuchs’ dystrophy, hinder the possibility to achieve 20/20 vision after Descemet’s membrane endothelial keratoplasty, according to one specialist.
“Although we all like to be conservative, we should consider intervening a little earlier in some of our patients, because the more you allow Fuchs’ dystrophy to be present in the cornea, the [worse] the visual results will be,” Jack Parker, MD, said at the European Society of Cataract and Refractive Surgeons Congress.
The Descemet’s membrane endothelial keratoplasty (DMEK) graft, which is purely Descemet’s membrane and integrates perfectly within the corneal stroma, should in theory restore the vision of a normal eye.
The reason this is not achieved might be related to the presence of anterior pathologies involved in Fuchs’ dystrophy, which DMEK does not address, according to Parker.
To validate this hypothesis, a cohort of 118 eyes was examined after DMEK with a Pentacam (Oculus) to measure anterior and posterior higher-order aberrations and with densitometry to detect corneal haze.
Average visual acuity was 20/25. Pentacam readings showed a significant decline in posterior corneal higher-order aberrations across all the individual aberrations. Densitometry measurement also showed a significant, obvious decrease of corneal haze, according to Parker.
“But no substantial decline was found in the anterior higher-order aberrations,” Parker said. “Obviously, the products of advanced Fuchs’, such as subepithelial fibrosis and anterior corneal scarring — which result from longstanding corneal edema — cause visual problems that do not disappear after anterior keratoplasty.”
Intervention in the earlier stages of the disease should therefore be considered, Parker concluded.
Disclosure: Parker has no relevant financial disclosures.