Visual Improvement and Optical Quality Changes After Keratoplasty in Macular Corneal Dystrophy in Romania

To evaluate visual and optical outcomes after penetrating keratoplasty in eyes with macular corneal dystrophy in Romania.

This observational study included 11 eyes from 6 patients with macular corneal dystrophy who underwent penetrating keratoplasty. Preoperative and 6-month postoperative assessments included best-corrected visual acuity, central corneal thickness, and anterior segment optical coherence tomography parameters obtained with the CSO MS-39, including higher-order aberrations at 3 mm, mean pupil power, cylinder, and point spread function expressed as the Strehl ratio. Continuous variables were summarized as mean ± standard deviation. Preoperative and postoperative values were compared using the Wilcoxon signed-rank test. Associations between preoperative central corneal thickness and other baseline variables were assessed using Spearman correlation.

Mean best-corrected visual acuity improved from 0.123 ± 0.090 preoperatively to 0.755 ± 0.082 at 6 months (p = 0.0010), corresponding approximately to an improvement from 0.91 to 0.12 logMAR. High-order aberrations at 3 mm increased from 0.269 ± 0.106 to 0.777 ± 0.523 (p = 0.0010), and cylinder magnitude increased from -1.42 ± 0.44 diopters to -8.15 ± 4.10 diopters (p = 0.0010). The Strehl ratio decreased from 0.214 ± 0.039 to 0.080 ± 0.024 (p = 0.0010). Mean pupil power increased from 42.60 ± 0.88 to 44.58 ± 2.55 without statistical significance (p = 0.0537). Preoperative central corneal thickness was positively correlated with age (rho = 0.699, p = 0.0167).

Our study underscores that even if visual quality metrics, such as higher-order aberrations and the point spread function, have decreased after keratoplasty, alongside a significant increase in astigmatism, penetrating keratoplasty still plays a very important role in restoring visual independence in patients with advanced macular dystrophy.

Penetrating keratoplasty in macular corneal dystrophy was associated with substantial improvement in visual acuity at 6 months, despite worsening in several optical quality metrics derived from anterior segment optical coherence tomography. These findings suggest that functional visual gain after keratoplasty may occur even when postoperative optical regularity does not improve.