One year follow up of descemet stripping only: corneal tomography changes and visual acuity outcomes.

Abstract

Background: Descemet Stripping Only (DSO) is a minimally invasive procedure for Fuchs' Endothelial Corneal Dystrophy (FECD) that leverages peripheral endothelial regeneration without donor tissue. This study evaluates visual and anatomical outcomes of DSO and the role of guttae distribution in recovery.

Methods: A prospective study included 30 eyes of FECD patients undergoing DSO. Patients were classified by guttae distribution: type A (central) or type B (0º-180º meridian). Preoperative and postoperative outcomes, including corrected distance visual acuity (CDVA), central corneal thickness (CCT), and endothelial cell density (ECD), were assessed over 12 months.

Results: Of 26 patients completing follow-up, 42.31% achieved a CDVA ≥ 0.22 logMAR by week 4, and 84.62% by month 12. Type B patients recovered faster, reaching CDVA ≥ 0.10 logMAR in 56 days versus 112 days for type A. Mean CCT improved from 606.96 ± 60.97 μm to 550.40 ± 29.67 μm (p = 0.0001). Postoperative ECD averaged 1402.7 ± 130.56 cells/mm². Corneal densitometry improved significantly but remained higher than controls.

Conclusions: DSO is an effective treatment for FECD with adequate peripheral endothelial reserve. Guttae distribution affects recovery speed, but final outcomes are similar. If no improvement occurs by the third month, a rescue DMEK is effective. Keratometry remains unchanged, epithelial thickness slightly increases, and corneal densitometry improves postoperatively.

Key messages: What is know: DSO is a donor-free surgical option for endothelial dystrophies like Fuchs' dystrophy, utilizing the eye's natural endothelial regenerative capacity in selected patients. Success relies on residual endothelial cell density and biomarkers like preoperative corneal thickness to predict regeneration outcomes.

What is new: Pattern of guttae distribution influences recovery timeline in DSO: Patients with type B guttae distribution (0º-180º meridian) achieve a CDVA of 0.1 logMAR faster than those with type A (central guttae), though finalvisual acuity, pachymetry, and endothelial cell density are similar at 12 months. DSO as an effective treatment for fuchs' endothelial corneal dystrophy: Descemet stripping only achieves corneal clearance in most cases within 3-4 months, with significant CDVA and quality of life improvements (NEI VFQ-25 scores), supporting its role as a minimally invasive alternative to donor graft surgeries.