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Comparison of Corneal Surface Higher-Order Aberrations After Endothelial Keratoplasty, Femtosecond Laser–Assisted Keratoplasty, and Conventional Penetrating Keratoplasty

Chamberlain, Winston MD, PhD; Omid, Nika MD; Lin, Amy MD; Farid, Marjan MD; Gaster, Ronald N MD; Steinert, Roger F MD

doi: 10.1097/ICO.0b013e3182151df2
Clinical Science

Purpose: To evaluate and compare corneal higher-order aberrations (HOAs) after Descemet stripping automated endothelial keratoplasty (DSAEK), femtosecond laser–assisted penetrating keratoplasty (FLAK), and conventional penetrating keratoplasty (PKP).

Methods: A retrospective comparison of consecutive surgical series of 67 eyes of 59 patients between 1.5 and 19 months after corneal transplant surgery (22, 34, and 11 corneas underwent DSAEK, FLAK, and PKP, respectively, by a single surgeon). The main outcome measures were anterior and posterior corneal surface HOAs (Zernike polynomials, third to eighth order) determined with Scheimpflug photography at 4.0- and 6.0-mm optical zones and best spectacle-corrected visual acuity (BSCVA) (logarithm of the minimum angle of resolution equivalents).

Results: DSAEK had fewer total anterior HOAs compared with FLAK [P = 5.27 × 10−5 (4.0 mm) and P = 1.02 × 10−5 (6.0 mm)] and PKP [P = 1.82 × 10−4 (4.0 mm) and P = 1.56 × 10−4 (6.0 mm)] but greater total posterior HOAs than FLAK [P = 0.001 (4.0 mm) and P = 0.007 (6.0 mm)] and PKP [at 4.0-mm optical zone (P = 0.047)]. FLAK had fewer total anterior and posterior HOAs than PKP, but differences were not statistically significant. DSAEK grafts exhibited statistically significantly greater posterior HOAs than either type of PKP. The magnitude of anterior and posterior HOAs weakly correlated with BSCVA.

Conclusions: DSAEK induces fewer anterior surface HOAs but greater posterior surface HOAs than FLAK or PKP. Differences between FLAK and PKP are not statistically significant. Anterior and posterior HOAs correlate weakly with poorer visual outcome and likely contribute to decreased BSCVA after keratoplasty.

Received for publication April 18, 2010; revision received January 7, 2011; accepted February 5, 2011.

From the *Casey Eye Institute, Oregon Health & Science University, Portland, OR; †Gavin Herbert Eye Institute, University of California, Irvine, CA; and ‡Department of Ophthalmology, Loyola University, Maywood, IL.

Drs. Winston Chamberlain, Nika Omid, Amy Lin, Marjan Farid, and Ronald N. Gaster have no disclosures.

Dr. Roger F. Steinert is a consultant to Abbott Medical Optics, but has no financial interest in the femtosecond laser or the techniques in this investigation.

Abbott Medical Optics provided supplies and equipment in support of the procedures.

Reprints: Winston Chamberlain, Casey Eye Institute, Oregon Health & Science University, 3375 SW Terwilliger Boulevard, Portland, OR 97239-4197 (e-mail:

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