title: Anterior corneal aberrations after Descemet's stripping endothelial keratoplasty for Fuchs' endothelial dystrophy.
abstract: OBJECTIVE
  To determine the change in anterior corneal high-order aberrations (HOAs) after Descemet's stripping endothelial keratoplasty (DSEK) for Fuchs' dystrophy, and to compare the HOAs with those of age-matched controls.
  
  
  METHODS
  Prospective cohort and cross-sectional study.
  
  
  METHODS
  Forty-eight eyes with Fuchs' dystrophy were examined before and after DSEK, and were compared with 52 eyes of age-matched controls with normal corneas.
  
  
  METHODS
  Corneas of patients with Fuchs' dystrophy were examined prospectively before and at intervals through 2 years after DSEK. Wavefront errors from the anterior corneal surface were derived from corneal topograms and were expressed as Zernike polynomials through the sixth order. Best-corrected visual acuity (BCVA) was measured by the electronic Early Treatment of Diabetic Retinopathy Study protocol, and subepithelial haze was measured from the brightness of confocal images. Total HOAs were compared before and after DSEK, and with those of age-matched controls, by using generalized estimating equation models. Relationships between HOAs, BCVA, subepithelial haze, and recipient age were determined.
  
  
  METHODS
  Anterior corneal HOAs, BCVA, and subepithelial haze (backscattered light).
  
  
  RESULTS
  In Fuchs' dystrophy before DSEK, total HOAs (4 mm optical zone) from the anterior corneal surface (0.29±0.13 μm) were higher than those of controls (0.17±0.08 μm; P<0.001). At 2 years after DSEK, total HOAs (0.26±0.13 μm) did not differ from preoperative aberrations (P = 0.99), and remained higher than in controls (P<0.001). At 2 years, total HOAs were correlated with BCVA (r = 0.59; P<0.001; n = 27), with subepithelial haze (r = 0.41; P = 0.01; n = 25), and with recipient age (r = 0.59; P<0.001; n = 27).
  
  
  CONCLUSIONS
  Anterior corneal HOAs are higher in Fuchs' dystrophy than in controls, and remain higher through 2 years after DSEK. The aberrated anterior surface might be related to anterior corneal ultrastructural changes and haze formation in Fuchs' dystrophy, and should not be ignored as a source of decreased visual acuity after DSEK.
authors.affiliation: Department of Ophthalmology, Mayo Clinic, Rochester, Minnesota, USA. patel.sanjay@mayo.edu
authors.forename: Sanjay V
authors.initials: SV
authors.lastname: Patel
authors.forename: Keith H
authors.initials: KH
authors.lastname: Baratz
authors.forename: Leo J
authors.initials: LJ
authors.lastname: Maguire
authors.forename: David O
authors.initials: DO
authors.lastname: Hodge
authors.forename: Jay W
authors.initials: JW
authors.lastname: McLaren
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019781:Corneal Topography; D057108:Corneal Wavefront Aberration / Q000209:etiology* / Q000503:physiopathology; D003430:Cross-Sectional Studies; D057111:Descemet Stripping Endothelial Keratoplasty; D004728:Endothelium, Corneal / Q000503:physiopathology / Q000637:transplantation; D005260:Female; D005642:Fuchs' Endothelial Dystrophy / Q000503:physiopathology / Q000601:surgery*; D019466:Glare; D006801:Humans; D008027:Light; D008297:Male; D018613:Microscopy, Confocal; D008875:Middle Aged; D011183:Postoperative Complications; D011446:Prospective Studies; D012307:Risk Factors; D012542:Scattering, Radiation; D014792:Visual Acuity / Q000502:physiology