Analysis of Corneal Scheimpflug Densitometry and Ocular Wavefront Aberrations Post Descemet Stripping Automated Endothelial Keratoplasty

Purpose: To assess the role of corneal densitometry and wavefront aberrations post Descemet stripping automated endothelial keratoplasty (DSAEK) and their correlation with visual acuity. Methods: Twenty-seven eyes of 25 patients with nonresolving corneal edema for more than 3 months as a result of Fuchs endothelial corneal dystrophy, pseudophakic bullous keratopathy, or secondary endothelial dysfunction were enrolled in a prospective interventional study and underwent DSAEK. Postoperative evaluation for corneal aberrations, including Higher order aberrations (HOAs) and corneal densitometry (CD), was performed using anterior-segment optical coherence tomography (Avanti RTvue XR; Optovue) and Scheimpflug imaging (Pentacam, Oculus Optikgerate GmbH, Wetzlar, Germany) at 6 months. A correlation analysis of corneal aberrations, including HOAs and CD, with postoperative best-corrected visual acuity at 6 months was performed. Results: Mean best-corrected visual acuity (BCVA) improved from 1.67 +/- 0.53 log of minimum angle of resolution (logMAR) to 0.2 +/- 0.22 logMAR post DSAEK at 6 months (P <= 0.0001). At 6 months, mean root-mean-square (RMS) total corneal aberrations (includes HOA and low-order aberration [LOA]), RMS total HOA, and RMS LOA of the central 6-mm zone were 4.99 +/- 2.64, 1.80 +/- 0.9, and 4.55 +/- 2.64, respectively. The mean corneal densitometry from anterior, central, and posterior zones were 39.12 +/- 12.77, 23.9 +/- 7.2, and 13.54 +/- 2.04 gray scale units, respectively. Total anterior aberrations (r=0.051; P=0.006), anterior LOA (r=0.049; P=0.009), total corneal aberrations (r=0.051; P=0.001), total HOAs (r=0.095; P=0.057) and LOAs (r=0.050; P=0.002), and total CD from 0 to 2 mm (r=0.010; P=0.038) and 2 to 6 mm (r=0.014; P=0.018) showed a significant inverse correlation with postoperative BCVA. Conclusion: There was an inverse relationship between post DSAEK BCVA and total corneal HOAs and full-thickness densitometry at 6 months. Scheimpflug imaging with added tools for corneal aberration and densitometry analysis gives further insight into the suboptimal vision achieved despite transparent corneas post DSAEK.