Effects of Descemet Stripping Automated Endothelial Keratoplasty on Corneal Densitometry of Cases with Long‑Standing Pseudophakic Bullous Keratopathy

To quantify the effects of Descemet stripping automated endothelial keratoplasty (DSAEK) on corneal clarity and densitometry of patients with long‑standing pseudophakic bullous keratopathy (PBK) complicated with subepithelial fibrosis.

Thirty‑four eyes with PBK complicated with corneal edema for more than 6 months and subepithelial fibrosis were enrolled. All subjects underwent complete ophthalmic examination and corneal densitometry module of Pentacam HR, before and 1, 3, and 6 months after DSAEK.

Thirteen patients were excluded due to postoperative complications or missed to follow‑up visits. Finally, twenty‑one patients’ data were analyzed. Corneal densitometry measures significantly decreased in all three layers (anterior, central, and posterior) 3 and 6 months after surgery compared to preoperative values; however, the differences did not reach statistical significance in the 1st month. Moreover, densitometry measurements were significantly lower at month 6 compared to month 1, but not at month 3 compared to month 1. Corneal densitometry of the anterior layer was significantly higher than central and posterior layers in 2 mm and 6 mm zones preoperatively and at all postoperative visits. Corneal light backscatter of each three layers was not statistically different between 0–2 mm and 2–6 mm in all pre‑ and postoperative visits.

Corneal densitometry in cases of PBK begins to improve after DSAEK in different layers in a slow and continued trend which takes up to 6 months for an effect to be seen. Interestingly, this improvement is possible even in complicated corneas with long‑standing edema. Hence, corneal densitometry can be used as an objective method for quantification of the outcome of DSAEK in complicated cases of PBK.