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Correlation of Straylight and Visual Acuity in Long-Term Follow-up of Manual Descemet Stripping Endothelial Keratoplasty

van der Meulen, Ivanka J. E. MD; van Riet, Tom C. T. MD; Lapid-Gortzak, Ruth MD; Nieuwendaal, Carla P. MD; van den Berg, Thomas J. T. P. PhD

doi: 10.1097/ICO.0b013e31823f8ab7
Clinical Science

Purpose Long-term quality of vision after Descemet stripping endothelial keratoplasty (DSEK) was evaluated and correlated with corneal characteristics and subjective complaints.

Methods Thirty-four eyes were examined; patients had a single visit 6 to 64 months after DSEK for Fuchs dystrophy. Best-corrected distance acuity (BCDA) and straylight were analyzed. To better evaluate long-term postoperative BCDA changes, longitudinal data were used from earlier visits. Corneal thickness was measured with the Visante anterior segment optical coherence tomography. Interface, stromal, and endothelial haze were semiquantitatively graded using the slit lamp. Vision-related quality of life was evaluated with the 39-item National Eye Institute Visual Function Questionnaire and a straylight questionnaire. Correlation analysis comparing corneal characteristics with visual quality was performed.

Results Mean postoperative time was 1027 ± 453 days. Mean BCDA at this time was 0.33 ± 0.19 logarithm of the minimal angle of resolution. BCDA remained stable with long-term postoperative follow-up. Straylight averaged 1.47 ± 0.19, on average 0.12 log units higher than normal for age-related pseudophakic eyes (P < 0.001). BCDA correlated with corneal haze (r = 0.50), whereas straylight showed a nonsignificant association (P = 0.12). Neither BCDA nor straylight correlated with corneal thickness. Mean Visual Function Questionnaire 39 score was 77/100, and mean score of the straylight questionnaire was 46/100.

Conclusion Quality of vision after DSEK does not return to normal levels of age-matched pseudophakic eyes, with decreased BCDA and increased straylight. Questionnaire scores indicate mild (Visual Function Questionnaire 39) to moderate (straylight) subjective visual impairment. Corneal thickness and haze do not offer an adequate explanation for the decreased visual quality.

*Department of Ophthalmology, Academic Medical Center, Amsterdam, the Netherlands

Netherlands Institute for Neuroscience, Netherlands Royal Academy, Amsterdam, the Netherlands

Reprints: Ivanka J. E. van der Meulen, Department of Ophthalmology, Academic Medical Center, A2 Room 123.1, Meibergdreef 9, 1100 DD Amsterdam, the Netherlands (e-mail:

Presented in part during the SOE congress, Amsterdam, June 15, 2009.

The Netherlands Academy of Arts and Sciences has a proprietary interest in the C-Quant Straylight meter.

No authors have any funding or conflicts of interest to disclose.

Received June 23, 2011

Accepted July 18, 2011

Copyright © 2012 Wolters Kluwer Health, Inc. All rights reserved.