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To evaluate the influence of lamellar thickness on visual recovery after Descemet stripping automated endothelial keratoplasty (DSAEK) and compare the results to penetrating keratoplasty (PK). Methods:A prospective case series of 20 eyes with pseudophakic bullous keratopathy (PBK) undergoing DSAEK.Lamellar graft thickness was measured at the visual axis using anterior segment OCT, by the same person, at various time points after DSAEK. Eyes were divided into groups based on Day One postoperative endothelial lamella thickness: standard (≤180 μm), medium-thick (>180 ≤ 250 μm) and thick (>250 μm). Outcome measurements were graft survival rate, best spectacle-corrected visual acuity (BSCVA), endothelial cell density loss (ECD), and degree of astigmatism. Results in DSAEK eyes were compared to 20 PBK eyes which underwent PK. Results:The median postoperative graft thickness of DSAEK eyes was 194.54 ± 47.61 μm. There was no significant difference in age, sex, or preoperative BSCVA between DSAEK groups. The postoperative follow-up period was 18 months. Eyes with lamellar grafts of ≤180 μm thickness showed better postoperative BSCVA and quicker recovery rates compared to the medium-thick and thick grafts (P<0.001). Only eyes receiving ≤180 μm thickness lamellar grafts achieved equivalent BSCVA as PK eyes at month 18. Medium-thick grafts needed a longer period to obtain BSCVA scores similar to thinner grafts, while thick grafts never achieved the BSCVA of standard and PK grafts. All DSAEK eyes with lamella of thickness ≤180 μm, and only 50% of those with medium-thick lamella, had reached a BSCVA of ≥ 0.5 at 6 months. Conclusions: Lamella of thickness ≤180 μm after DSAEK ensured a better and quicker visual recovery than thicker grafts.

Descemet Stripping Automated Endothelial Keratoplasty – Is a Thinner Donor Lamella the Better Choice?