title: Comparison of corneal surface higher-order aberrations after endothelial keratoplasty, femtosecond laser-assisted keratoplasty, and conventional penetrating keratoplasty.
abstract: OBJECTIVE
  To evaluate and compare corneal higher-order aberrations (HOAs) after Descemet stripping automated endothelial keratoplasty (DSAEK), femtosecond laser-assisted penetrating keratoplasty (FLAK), and conventional penetrating keratoplasty (PKP).
  
  
  METHODS
  A retrospective comparison of consecutive surgical series of 67 eyes of 59 patients between 1.5 and 19 months after corneal transplant surgery (22, 34, and 11 corneas underwent DSAEK, FLAK, and PKP, respectively, by a single surgeon). The main outcome measures were anterior and posterior corneal surface HOAs (Zernike polynomials, third to eighth order) determined with Scheimpflug photography at 4.0- and 6.0-mm optical zones and best spectacle-corrected visual acuity (BSCVA) (logarithm of the minimum angle of resolution equivalents).
  
  
  RESULTS
  DSAEK had fewer total anterior HOAs compared with FLAK [P = 5.27 × 10(-5) (4.0 mm) and P = 1.02 × 10(-5) (6.0 mm)] and PKP [P = 1.82 × 10(-4) (4.0 mm) and P = 1.56 × 10(-4) (6.0 mm)] but greater total posterior HOAs than FLAK [P = 0.001 (4.0 mm) and P = 0.007 (6.0 mm)] and PKP [at 4.0-mm optical zone (P = 0.047)]. FLAK had fewer total anterior and posterior HOAs than PKP, but differences were not statistically significant. DSAEK grafts exhibited statistically significantly greater posterior HOAs than either type of PKP. The magnitude of anterior and posterior HOAs weakly correlated with BSCVA.
  
  
  CONCLUSIONS
  DSAEK induces fewer anterior surface HOAs but greater posterior surface HOAs than FLAK or PKP. Differences between FLAK and PKP are not statistically significant. Anterior and posterior HOAs correlate weakly with poorer visual outcome and likely contribute to decreased BSCVA after keratoplasty.
authors.affiliation: Casey Eye Institute, Oregon Health & Science University, Portland, OR 97239-4197, USA. chamberw@ohsu.edu
authors.forename: Winston
authors.initials: W
authors.lastname: Chamberlain
authors.forename: Nika
authors.initials: N
authors.lastname: Omid
authors.forename: Amy
authors.initials: A
authors.lastname: Lin
authors.forename: Marjan
authors.initials: M
authors.lastname: Farid
authors.forename: Ronald N
authors.initials: RN
authors.lastname: Gaster
authors.forename: Roger F
authors.initials: RF
authors.lastname: Steinert
mesh_terms: D000368:Aged; D019781:Corneal Topography; D057108:Corneal Wavefront Aberration / Q000209:etiology*; D057111:Descemet Stripping Endothelial Keratoplasty / Q000009:adverse effects*; D005260:Female; D006801:Humans; D015948:Keratoplasty, Penetrating / Q000009:adverse effects* / Q000379:methods; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D014792:Visual Acuity