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Preoperative Visual Acuity, Age Are Main Outcome Predictors for New Procedure: Presented at AAO By Cameron Johnston NEW ORLEANS, LA -- November 13, 2007 -- Age and preprocedure visual acuity appear to be the 2 strongest predictors of outcome following Descemet stripping automated endothelial keratoplasty (DSAEK) surgery to treat intracorneal disease such as Fuchs' syndrome. The findings -- presented in a poster session here yesterday at the annual meeting of the American Academy of Ophthalmology (AAO) -- could ultimately help patients undergoing the procedure understand what kind of results they may expect. Until quite recently, patients with Fuchs' syndrome, a disease of the corneal endothelium, have had little in the way of treatment options. Cornea transplant, if available, was usually their only hope. More recently, DSAEK has emerged as an important -- though very new -- treatment. It appears to afford these patients a superior treatment with less time spent waiting for a corneal transplant and less risk of complications once the transplant material became available. The DSAEK procedure entails opening the edge of the cornea with a small slit, similar to what the ocular surgeon would do when removing a cataract, then "scraping" the inner layer of the cornea to remove the diseased tissue. The endothelium is then replaced with a new layer consisting of a cadaver cornea that has had the 3 outer-most layers "shaved" off. This section of cornea is folded into a taco shape and inserted inside the recipient's open anterior chamber where it is held in place, against the diseased cornea, with compressed air. The strength of preoperative visual acuity and patient's age in predicting outcome after DSAEK surgery was uncovered in a chart review of 120 cases. Six months after the procedure, patients less than 60 years of age had a mean visual acuity (VA) of 20/25, while patients who were more than 60 years of age had a mean VA of 20/32 (P <.001). Eyes with a preoperative VA of 20/40 or better had a follow-up VA of 20/25, while patients whose VA was worse than 20/40 had a mean VA at follow-up of 20/32 (P <.001). Interestingly, there was no correlation between the patient's corneal thickness and outcome 6 months postoperatively. Patients whose corneal thickness before the surgery was less than 700 microns had a 6-month VA of 20/30, compared with 20/32 for patients whose corneal thickness greater than 700 microns. The authors, led by Neda Shamie, MD, Ophthalmologist, Devers Eye Institute, Portland, Oregon, United States, said that understanding these patient factors that are predictive of a good outcome after DSAEK can help with preoperative counselling and may assist doctors in determining the best time for surgery. Understanding these factors may also help the patient develop realistic expectations as to what this new method of surgical treatment may mean for this painful disease. [Presentation title: Descemet-Stripping Automated Endothelial Keratoplasty: Predictive Factors for Good Visual Acuity at 6 Months. Abstract PO289] E-mail this page to a friend or colleague! To print, use this version