Vision-related Quality of Life Before and After Keratoplasty for Fuchs' Endothelial Dystrophy

• Published in: Ophthalmology (Rochester, Minn.) Vol. 121; no. 11; pp. 2147 - 2152
• Main Authors: Trousdale, Eleanor R., Hodge, David O., Baratz, Keith H., Maguire, Leo J., Bourne, William M., Patel, Sanjay V.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.11.2014
• Subjects: Adult; Aged; Aged, 80 and over; Corneal Transplantation - psychology; Descemet Stripping Endothelial Keratoplasty - psychology; Female; Follow-Up Studies; Fuchs' Endothelial Dystrophy - psychology; Fuchs' Endothelial Dystrophy - surgery; Glare; Humans; Keratoplasty, Penetrating - psychology; Male; Middle Aged; Ophthalmology; Prospective Studies; Quality of Life - psychology; Sickness Impact Profile; Surveys and Questionnaires; Vision, Ocular - physiology; Visual Acuity - physiology; PK; NEI-VFQ-25; DSEK; EK; DLEK; endothelial keratoplasty; penetrating keratoplasty; Descemet stripping endothelial keratoplasty; National Eye Institute Visual Functioning Questionnaire; deep lamellar endothelial keratoplasty
• ISSN: 0161-6420; 1549-4713; 1549-4713
• DOI: 10.1016/j.ophtha.2014.04.046

To assess vision-related quality of life in Fuchs' dystrophy and changes in vision-related quality of life after 3 types of keratoplasty (penetrating keratoplasty [PK], deep lamellar endothelial keratoplasty [DLEK], and Descemet stripping endothelial keratoplasty [DSEK]). Prospective, observational case series. Sixty-three subjects with Fuchs' endothelial dystrophy: 12 subjects (12 eyes) received PK, 11 subjects (11 eyes) received DLEK, and 40 subjects (40 eyes) received DSEK. Subjects were examined before keratoplasty and at regular intervals through 3 years after keratoplasty. At each examination, vision-related quality of life was assessed using the 25-item National Eye Institute Visual Functioning Questionnaire; best spectacle-corrected and uncorrected visual acuities were measured by using the electronic Early Treatment of Diabetic Retinopathy Study protocol; keratometric cylinder was measured by a manual keratometer. Disability glare was measured with a straylight meter. Vision-related quality of life composite score. Vision-related quality of life composite score for all eyes with Fuchs' dystrophy before keratoplasty was 72±11 (n = 63) and did not differ between groups (P = 0.88). Vision-related quality of life improved by 6 months (PK, P = 0.008; DLEK, P = 0.03; DSEK, P < 0.001), with continued improvement between 6 months and 3 years after PK (P = 0.01) and DSEK (P = 0.004). At 6 months, the composite score was higher after DSEK than after PK (P = 0.006). At 3 years, there were no differences in composite scores between the 3 treatments (P = 0.33; mean minimum detectable difference, 8 [α = 0.05; β = 0.20]). After keratoplasty, quality of life was correlated with uncorrected visual acuity at 1 year (r = −0.38; P = 0.001) and at 3 years (r = −0.36; P = 0.02), with disability glare at 3 years (r = −0.41; P = 0.02), and with best-corrected visual acuity at 6 months (r = −0.34; P = 0.03), but not thereafter. Vision-related quality of life in patients with Fuchs' endothelial dystrophy is significantly impaired but improves after keratoplasty, irrespective of the technique. The improvement is faster after DSEK than after PK, and this might be explained in part by rapid improvement in uncorrected visual acuity after DSEK. This study affirms an advantage of endothelial keratoplasty over PK with respect to patient-reported outcomes.