Purpose: To determine whole-eye high-order aberrations (HOAs) in pseudophakic eyes after Descemet stripping endothelial keratoplasty (DSEK) for Fuchs dystrophy, and to establish relationships between graft thickness, HOAs, and visual acuity. Design: Cross-sectional study. Methods: Whole-eye HOAs were measured in pseudophakic eyes at intervals through 24 months after DSEK, and in otherwise healthy pseudophakic control eyes implanted with the same type of spherical intraocular lens. Wavefront errors were assessed by a Hartmann-Shack aberrometer over a 4-mm-diameter optical zone. In DSEK eyes, central graft thickness and stromal graft folds were measured using confocal microscopy in vivo, and best-corrected visual acuity (BCVA) was determined by the electronic Early Treatment of Diabetic Retinopathy Study method. Results: Total HOAs at 24 months after DSEK (0.28 ± 0.11 μm, mean ± SD, n = 17) were higher than those in pseudophakic controls (0.16 ± 0.07 μm, n = 25, P <.001); specifically, trefoil and quadrafoil were higher after DSEK. At 24 months, total HOAs (r = 0.69, P <.001) and graft folds (r = 0.41, P =.02) were correlated with central graft thickness, and BCVA was correlated with total HOAs (r = 0.39, P =.01) but not with graft thickness (r = -0.24, P =.20, n = 27). Conclusions: Whole-eye HOAs are higher after DSEK compared to untreated corneas. Thicker grafts are associated with increased HOAs and more graft folds, suggesting that the donor lenticule contributes, in part, to the wavefront errors. Although BCVA is weakly related to total HOAs after DSEK, it is not related to graft thickness.
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