1. Corneal Densitometry and Visual Outcome Comparisons of DSAEK and DMEK Eyes Xiaolin Zhang MD Robert L. Schultze MD Robert A. Eden MD Rahul Raghu

2. Financial Disclosure Robert L. Schultze is a member of the speaker’s bureau and receives research funding from Bausch + Lomb, Inc. All other authors have no financial interests to disclose

3. Introduction DSAEKDMEK Easier technique Applicable to more diseased eyes (ie-post vitrectomy, ACIOL, post glaucoma surgeries) Less dislocation rates Faster visual recovery Better visual outcomes Less endothelial rejection

4. Hypothesis Faster and better visual outcomes in DMEK vs. DSAEK could be related to differences in corneal light scatter, which is measured as corneal optical densitometry (CD).

5. Purpose To compare pre-op and 6-month post-op corneal densitometry (CD) and visual outcomes in patients undergoing either Descemet’s stripping automated endothelial keratoplasty (DSAEK) or Descemet membrane endothelial keratoplasty (DMEK) surgery

6. Methods Retrospective review of 46 DMEK and 32 DSAEK surgeries for treatment of Fuchs’ dystrophy. Eyes with non-corneal vision limiting pathologies were excluded. DMEK and DSAEK eyes were matched to similar pre-op visual acuity and pachymetry. Pre-op and 6 month post-op corrected distance visual acuity (CDVA), CD, and pachymetry were collected. CD was measured using the Oculus Pentacam® tomography and reported in standardized greyscale units (GSU). Data was analyzed using t-test and Wilcoxon rank-sum and signed-rank tests.

7. LogMAR Visual Acuity Pre-op LogMAR VAPost-op LogMAR VA P=0.002 DSAEK DMEK

8. Pachymetry Pre-op Pachymetry Post-op Pachymetry P<0.001 DSAEK DMEK µm

9. Corneal Densitometry Pre-op CD Post-op CD P<0.001 DSAEK DMEK GSU

10. Change from pre-op to 6 months post-op DSAEK (n=32)DMEKP-value between groups Mean Change in LogMAR VA 0.10 (p=0.0039)0.28 (p<0.001) (n=46) <0.001 Mean Change in Pachymetry (µm) 7.19 (p=0.627)130.16 (p=<0.001) (n=45) <0.001 Mean Change in Corneal Densitometry (GSU) 9.09 (p<0.001)3.08 (p<0.001) (n=28) <0.001

11. Conclusion DMEK appears to provide better visual outcomes compared to DSAEK surgery. Corneal densitometry measurements improved as a result of both surgeries. Possible selection bias due to worse pre-op corneal densitometry readings in DSAEK vs. DMEK eyes which could be why there was a greater reduction in mean CD in DSAEK vs. DMEK eyes. Further studies with larger sample size are needed to confirm these findings.

12. References Vira S, Shih CY, Ragusa N, Sheyman A, Feder R, Weisenthal RW, Rosenwasser GO, Hannush SB, Udell IJ, Bouchard CS. Textural interface opacity after Descemet stripping automated endothelial keratoplasty: a report of 30 cases and possible etiology. Cornea 2013; 32:e54–e59 Kymionis GD, Ide T, Yoo SH. Interface wavelike deposits after Descemet stripping automated endothelial keratoplasty. Arch Ophthalmol 2009; 127:1389–1390. de Sanctis U, Brusasco L, Grignolo F. Wave-like opacities at the interface after Descemet stripping automated endothelial keratoplasty. Cornea 2012; 31:1335–1338 Anshu A, Planchard B, Price MO, da Pereira C, Price FW Jr. A cause of reticular interface haze and its management after Descemet stripping endothelial keratoplasty. Cornea 2012; 31:1365– 1368 Baratz KH, McLaren JW, Maguire LJ, et al. Corneal haze determined by confocal microscopy 2 years after Descemet stripping with endothelial keratoplasty for Fuchs corneal dystrophy. Arch Ophthalmol 2012;130:868–74. Price F, Ambrósio R, Kwon R, et al. Pentacam characterization of corneas with Fuchs dystrophy treated with descemet membrane endothelial keratoplasty. J Refract Surg 2010;26:972–9. Shinton AJ, Tsatsos M, Konstantopoulos A, et al. Impact of graft thickness on visual acuity after Descemet’s stripping endothelial keratoplasty. Br J Ophthalmol 2012;96:246–9.