title: Determinants of visual quality after endothelial keratoplasty.
abstract: Endothelial keratoplasty is now favored over full-thickness penetrating keratoplasty for corneal decompensation secondary to endothelial dysfunction. Although endothelial keratoplasty has evolved as surgeons strive to improve outcomes, fewer patients than expected achieve best corrected visual acuity of 20/20 despite healthy grafts and no ocular comorbidities. Reasons for this remain unclear, with theories including anterior stromal changes, differences in graft thickness and regularity, induced high-order aberrations, and the nature of the graft-host interface. Newer iterations of endothelial keratoplasty such as thin manual Descemet stripping endothelial keratoplasty, ultrathin automated Descemet stripping endothelial keratoplasty, and Descemet membrane endothelial keratoplasty have achieved rates of 20/20 acuity of approximately 50%, comparable to modern cataract surgery, and it may be that a ceiling exists, particularly in the older age group of patients. Establishing the relative contribution of the factors that determine visual quality following endothelial keratoplasty will help drive further innovation, optimizing visual and patient-reported outcomes while improving surgical efficacy and safety.
authors.affiliation: Department of Ophthalmology, Cornea and External Disease Service, University Hospital Southampton, Southampton, UK. Electronic address: andyt@doctors.org.uk.
authors.forename: Andrew M J
authors.initials: AM
authors.lastname: Turnbull
authors.affiliation: Moorfields Eye Hospital, London, UK; Modern Eye Centre, Thessaloniki, Greece.
authors.forename: Michael
authors.initials: M
authors.lastname: Tsatsos
authors.affiliation: Department of Ophthalmology, Cornea and External Disease Service, University Hospital Southampton, Southampton, UK; Division of Infection, Inflammation and Immunity, Faculty of Medicine, University of Southampton, Southampton, UK.
authors.forename: Parwez N
authors.initials: PN
authors.lastname: Hossain
authors.affiliation: Department of Ophthalmology, Cornea and External Disease Service, University Hospital Southampton, Southampton, UK; University of Southampton, Southampton, UK.
authors.forename: David F
authors.initials: DF
authors.lastname: Anderson
mesh_terms: D003317:Corneal Dystrophies, Hereditary / Q000503:physiopathology / Q000601:surgery*; D015715:Corneal Edema / Q000503:physiopathology / Q000601:surgery*; D057111:Descemet Stripping Endothelial Keratoplasty; D004728:Endothelium, Corneal / Q000473:pathology / Q000601:surgery*; D006801:Humans; D015948:Keratoplasty, Penetrating; D014792:Visual Acuity / Q000502:physiology*
keywords: Descemet membrane; aberrations; cornea; endothelial keratoplasty/DSEK/DSAEK/DMEK; optics; visual acuity; visual quality