Influence of Early Descemet Stripping Endothelial Keratoplasty on Visual Outcomes in Pseudophakic Corneal Edema

Purpose Longstanding corneal edema can lead to anterior stromal scarring that may limit visual acuity following Descemet stripping endothelial keratoplasty (DSEK). The ideal time to perform DSEK to prevent permanent changes is unclear. Our aim is to determine whether earlier DSEK is associated with improved visual outcomes. Design Cohort study. Methods Setting: Institutional. Study Population: Total of 120 eyes of patients who underwent DSEK for corneal edema following cataract surgery (CE); 87% of eyes had a diagnosis of Fuchs dystrophy. Intervention: Post-DSEK visual acuity was compared in patients who underwent DSEK ≤6 months vs >6 months after CE. Linear and logistic regression were performed to assess the relationships between DSEK timing and best spectacle-corrected visual acuity (BSCVA) while accounting for baseline preoperative patient characteristics. Main Outcome Measures: Postoperative best-corrected visual acuity 6 months after DSEK (POM6 BSCVA). Results Median CE-to-DSEK time was 8.62 (interquartile range [IQR] 12.28) months (n = 120). Overall median preoperative VA and POM6 BSCVA were 0.54 (IQR 0.68) and 0.24 (IQR 0.16), respectively. Median POM6 BSCVA was better in patients with CE-to-DSEK time ≤6 months (median 0.18, IQR 0.19) vs >6 months (median 0.30, IQR 0.21) ( P  = .014). A significant relationship was found between CE-to-DSEK time and POM6 BSCVA (coefficient = 0.002, P  = .033), accounting for preoperative vision and pachymetry. Patients who underwent DSEK ≤6 months after CE were more likely to achieve POM6 BSCVA better than 20/40 (odds ratio = 3.73 P  = .035). Conclusion Performing earlier DSEK for pseudophakic corneal edema appears to be associated with improved vision. Further prospective study is warranted to determine the optimal time to perform DSEK in patients with pseudophakic corneal edema.