Transcript Title of article

Quality of Vision in Patients
With Fuchs Endothelial Dystrophy and After
Descemet Stripping Endothelial Keratoplasty
van der Meulen IJE, Patel SV, Lapid-Gortzak R, Nieuwendaal
CP, McLaren JW, van den Berg TJTP. Quality of vision in
patients with Fuchs endothelial dystrophy and after Descemet
stripping endothelial keratoplasty. Arch Ophthalmol. Published
online August 8, 2011. doi:10.1001/archophthalmol.2011.247.
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Introduction
•
Patients with Fuchs dystrophy may have decreased quality of vision
caused by increased forward light scatter in addition to decreased visual
acuity.
•
Straylight (disability glare) is a functional term that denotes scattered light
falling on the retina as observed by the patient and is proportional to
forward light scatter.
•
This study evaluated the quality of vision (visual acuity and straylight) in
patients with Fuchs dystrophy and the improvement in visual quality after
Descemet stripping endothelial keratoplasty (DSEK).
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Methods
•
Patients with phakic and pseudophakic eyes with Fuchs dystrophy were
recruited at 2 centers:
– Observational case series: Academic Medical Center, Amsterdam, the
Netherlands (99 eyes).
– Prospective interventional case series: Mayo Clinic, Rochester,
Minnesota (48 eyes).
• Patients in the Mayo group were also examined at 1, 3, 6, and 12
months after DSEK.
• All these eyes were rendered pseudophakic during DSEK.
•
Outcome measures:
– High-contrast corrected distance visual acuity (CDVA) using Early
Treatment Diabetic Retinopathy Study protocol.
– Straylight using Oculus C-Quant straylight meter.
– Central corneal thickness using ultrasonic pachymeter.
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Methods
•
Straylight of phakic eyes with Fuchs endothelial dystrophy was
compared with that of age-matched normal eyes using 2-tailed
unpaired t tests.
•
Straylight of pseudophakic eyes with Fuchs endothelial dystrophy was
compared with that of normal pseudophakic eyes using 2-tailed
unpaired t tests.
•
Correlations were examined by using the bivariate Pearson method or,
when data were not normally distributed, the Spearman ρ coefficient.
•
P < .05 was considered statistically significant.
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Results
•
Eyes with Fuchs dystrophy had decreased CDVA and increased
straylight compared with normal eyes.
•
Younger patients were affected more by increased straylight than by
decreased CDVA.
•
Straylight and CDVA improved significantly at all postoperative
examinations.
•
Postoperative improvement in straylight was more predictable than that
of CDVA and was correlated with preoperative straylight. Eyes with
preoperative straylight higher than 1.33 logarithm of the straylight
parameter (log[s]) consistently improved after DSEK.
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Results
B
A
Straylight as a function of age for the Amsterdam and Mayo patients with phakic (A) and
pseudophakic (B) eyes and Fuchs endothelial dystrophy. Straylight was increased compared with
normal eyes in patients of the same age (P < .01), especially in younger patients. The central
black line represents average straylight in healthy phakic (A) and pseudophakic (B) eyes. The
dotted lines represent ±0.2 log intervals.
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Results
Visual Quality Before and After DSEK for Fuchs Endothelial Dystrophy
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Results
Postoperative improvement in
straylight as a function of
preoperative straylight values. After
DSEK, straylight improved to
approximately 1.35 log(s),
regardless of preoperative
straylight. As a consequence,
postoperative improvement in
straylight was correlated with
preoperative straylight. The
regression line (solid line) shows
that eyes with preoperative
straylight higher than 1.33 log(s)
can be expected to improve after
DSEK.
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Comment
•
Straylight and CDVA are severely impaired in Fuchs dystrophy, and both
improve significantly after DSEK.
•
Younger patients with Fuchs dystrophy are affected more by increased
straylight than by decreased visual acuity, and straylight improves more in
younger eyes than in older eyes after DSEK.
•
Postoperative improvement in straylight is associated with preoperative
straylight more than 1.33 log(s).
•
Straylight is easily measured in the clinic and could be a useful clinical
metric to determine the timing of surgery, especially in young, symptomatic
patients whose CDVA is close to 20/20.
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Contact Information
•
If you have questions, please contact the corresponding author:
– Ivanka J. E. van der Meulen, MD, Department of Ophthalmology,
A2 Room 123.1, Academic Medical Center, Meibergdreef 9, 1100 DD,
Amsterdam, the Netherlands ([email protected]).
Funding/Support
•
This work was supported in part by Research to Prevent Blindness
(an unrestricted grant to the Department of Ophthalmology, Mayo Clinic,
Rochester, Minnesota, and Dr Patel as an Olga Keith Wiess Special
Scholar) and the Mayo Foundation, Rochester.
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