Quality of Vision in Eyes after Selective Lamellar Keratoplasty

With the increasing popularity of selective lamellar keratoplasty procedures, it is important to characterize the optical differences among penetrating keratoplasty (PK), deep anterior lamellar keratoplasty (DALK), and Descemet stripping automated endothelial keratoplasty (DSAEK). The impact of optical differences on the visual acuity (VA) in eyes after keratoplasty is significant. Quantitative evaluation of corneal higher-order aberrations (HOAs) of anterior and posterior surfaces using a rotating Scheimpflug-based corneal topographer, showed that eyes that undergo DSAEK have lower anterior corneal HOAs compared with eyes subjected to PK or DALK. In DSAEK, the anterior corneal surfaces are not replaced, which is in contrast to PK or DALK, where they are replaced. Through evaluation of corneal scatter with a densitometry program associated with the rotating Scheimpflug-based corneal topographer, 3 characteristic patterns of corneal scatter were found in eyes that had undergone keratoplasty. Investigation of the impact of corneal HOAs and corneal scatter on VA after keratoplasty showed that the VA was correlated significantly with corneal scatter.