Purpose. To compare the higher-order aberrations (HOAs) due to the anterior and posterior corneal surfaces in patients that underwent either Descemet-stripping-automated-endothelial-keratoplasty (DSAEK) or penetrating keratoplasty (PK) for endothelial dysfunction and age-matched controls. Methods. This retrospective, observational, case series included 28 patients after PK, 30 patients after DSAEK, and 30 healthy controls. A Scheimpflug imaging system was used to assess the HOAs due to the anterior and posterior corneal surfaces at 4？mm and 6？mm optical zones. Total, 3rd and 4th order HOAs were considered. Intra- and intergroup differences were assessed using the Friedman and the Kruskal-Wallis tests, respectively; paired comparisons were performed using Duncan's multiple range test. Results. Total, 3rd and 4th order HOAs due to both corneal surfaces at 4？mm and 6？mm optical zones were significantly higher in the PK group, intermediate in the DSAEK group, and lower in controls ( ). The most important HOAs components in both PK and DSAEK groups were trefoil and coma from the anterior corneal surface ( ) and trefoil from the posterior corneal surface ( ). Conclusions. The optical quality of both corneal surfaces appeared significantly higher after DSAEK than after PK, which can increase the postoperative patient's quality of vision and satisfaction. 1. Introduction Endothelial keratoplasty (EK) is nowadays considered as the procedure of choice for the treatment of the endothelial dysfunctions [1]. The technique is based on the selective replacement of diseased endothelium, while leaving the healthy recipient anterior cornea structurally intact. EK has been shown to be a better procedure than penetrating keratoplasty (PK) due to faster postoperative visual recovery, minimal induced topographic changes, lower refractive error, higher refraction predictability and stability, absence of suture-related complications, better corneal structural integrity and innervation maintenance, and reduced risk of graft rejection [2–4]. The surgical technique has undergone modifications and improvements over the years, which include the following methods in chronologic order: posterior lamellar keratoplasty (PLK) [5], deep lamellar endothelial keratoplasty (DLEK) [6], Descemet stripping endothelial keratoplasty (DSEK) [7], Descemet stripping and automated endothelial keratoplasty (DSAEK) [8–10], and Descemet membrane endothelial keratoplasty (DMEK) [11]. The DSAEK technique, which currently tends to be the preferred EK surgical approach used in many centers, involves the
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