Case Reports

Different graft thicknesses after Descemet stripping endothelial keratoplasty for bullous keratopathy in the two eyes of the same patient

Case Report Details

First Author: R.Napolitano ITALY

Co Author(s):    L. Spadea   E. Tonti                 

Abstract Details

Purpose:

To describe a very unique case of two Descemet stripping automated endothelial keratoplasty (DSAEK) surgeries performed in both eyes of the same patient with an extremely different graft thickness and overall corneal thickness but with the same corrected distance visual acuity (CDVA) 2 years after surgery.

Setting:

Eye Clinic, Policlinico “Umberto I”, “Sapienza” University of Rome.

Report of Case:

DSAEK surgeries in both eyes in a 75-year-old woman with bilateral bullous keratopathy (BK), first in right and after 6 months in left eye. CDVA was 20/160 in the right eye and 20/63 in the left eye. Corneal thickness evaluated by anterior segment optical coherence tomography was 569 μm in the right eye and 560 μm in the left eye. The root mean square (RMS) was 2.1 in both eyes. Endothelial cell densities were not detectable. The estimated precut donor graft thickness was 250 and 40 μm in the right and in the left graft, respectively. Two years after surgery CDVA was 20/25 in both eyes. Corneal thickness was 633 μm with a lenticule thickness of 206 μm in the right eye and 439 μm with a lenticule thickness of 48 μm in the left eye. The RMS was 1.7 in the right eye and 1.4 in the left eye. Endothelial cell density was 2.272 cells/mm2 in the right and 2.154 cells/mm2 in the left eye.

Conclusion/Take Home Message:

In the two eyes of our patient, the post-operative overall corneal thickness and graft thickness was very different, resulting in the same CDVA, suggesting the small importance of the thickness on the final outcome. Although the contrasting evidence that graft thickness is related to better CDVA after DSAEK, several findings of various authors suggests a weak relationship. Our report describes an extreme difference of post-operative graft thickness with comparable high-order aberrations in the two eyes of the same patient that leads to same final visual acuity. Even though well-designed longitudinal studies with standardized measurements of visual acuity and graft thickness are necessary to better clarify this relationship, current evidence and our report suggest that graft thickness is not the main predictive factor of final visual acuity.

Financial Disclosure:

None