title: Effect of preoperative duration of stromal edema in bullous keratopathy on early visual acuity after endothelial keratoplasty.
abstract: OBJECTIVE
  To clarify the relationship between visual acuity after Descemet-stripping automated endothelial keratoplasty (DSAEK) and the preoperative duration of stromal edema.
  
  
  METHODS
  Yamaguchi University Hospital, Yamaguchi, Japan.
  
  
  METHODS
  Comparative case series.
  
  
  METHODS
  Patients who had DSAEK were divided into 2 groups based on whether the preoperative duration of stromal edema was less than 12 months (Group A) or more than 12 months (Group B). No patient had postoperative conditions that might have affected postoperative visual outcomes. Postoperatively, the corrected distance visual acuity (CDVA) was measured and the morphology of the anterior cornea evaluated by in vivo laser confocal microscopy.
  
  
  RESULTS
  The postoperative CDVA in Group A ranged from 20/50 to 20/16 at 3 months and from 20/66 to 20/16 at 6 months; the maximum CDVA was 20/40 to 20/13. The postoperative CDVA in Group B ranged from 20/66 to 20/40 at 3 months and 6 months; the maximum CDVA was 20/66 to 20/33. The structure of the anterior cornea was normal in patients in Group A but was abnormal with fibroblastic cells in the anterior stroma in patients in Group B.
  
  
  CONCLUSIONS
  Patients with a preoperative duration of stromal edema of more than 12 months had pathologic changes in the corneal stroma that may have adversely affected visual acuity after DSAEK. Given that stromal edema, including that associated with bullous keratopathy, has been proposed to be a progressive condition, DSAEK may be most effective when performed early after the onset of edema, before the occurrence of pathologic changes in the stroma.
authors.affiliation: Department of Ophthalmology, Yamaguchi University Graduate School of Medicine, Ube, Yamaguchi, Japan. morishig@yamaguchi-u.ac.jp
authors.forename: Naoyuki
authors.initials: N
authors.lastname: Morishige
authors.forename: Tai-ichiro
authors.initials: T
authors.lastname: Chikama
authors.forename: Naoyuki
authors.initials: N
authors.lastname: Yamada
authors.forename: Norihisa
authors.initials: N
authors.lastname: Takahashi
authors.forename: Yukiko
authors.initials: Y
authors.lastname: Morita
authors.forename: Teruo
authors.initials: T
authors.lastname: Nishida
authors.forename: Koh-Hei
authors.initials: KH
authors.lastname: Sonoda
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001768:Blister / Q000503:physiopathology / Q000601:surgery*; D003316:Corneal Diseases / Q000503:physiopathology / Q000601:surgery*; D015715:Corneal Edema / Q000503:physiopathology*; D003319:Corneal Stroma / Q000473:pathology*; D057111:Descemet Stripping Endothelial Keratoplasty; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D018613:Microscopy, Confocal; D008875:Middle Aged; D057234:Preoperative Period; D013997:Time Factors; D014792:Visual Acuity / Q000502:physiology*