Corneal Wavefront Errors 24 Months after Deep Lamellar Endothelial Keratoplasty and Penetrating Keratoplasty

Purpose: To evaluate high-order aberrations (HOA) induced by the anterior corneal surface after deep lamellar endothelial keratoplasty (DLEK) and penetrating keratoplasty (PK). Design: Prospective, randomized clinical trial. Methods: Twenty-eight eyes of 25 patients with corneal edema resulting from Fuchs dystrophy underwent DLEK with a 9- to 10-mm incision (n = 13) or PK with double-running sutures (n = 15) at the Cornea Service, Mayo Clinic Department of Ophthalmology, Rochester, Minnesota. The main outcome measures were HOA from the anterior corneal surface calculated from corneal topography and decomposed into Zernike polynomials to the sixth order, high- and low-contrast visual acuity (VA), and contrast sensitivity. Variables after surgery were compared with those before surgery and between treatments by using generalized estimating equation models with Bonferroni adjustment. Results: Total HOA through 24 months (0.48 ± 0.15 μm) after DLEK was similar to total aberration before surgery (0.44 ± 0.23 μm; P = .10). After PK, total HOA remained elevated through 24 months (1.68 ± 0.58 μm) compared with that before surgery (0.49 ± 0.27 μm; P < .005) and compared with that after DLEK (P < .006). At 24 months after PK, corneas with sutures removed had greater total HOAs than corneas with sutures intact (1.90 ± 0.52 μm vs 1.18 ± 0.33 μm; P = .001). High- and low-contrast VA and contrast sensitivity at 24 months after PK did not correlate with any HOA. Conclusions: HOAs from the anterior corneal surface were higher after PK compared with after DLEK but did not correlate with visual function after PK.