Descemet-Stripping Automated Endothelial Keratoplasty: Six-month Results in a Prospective Study of 100 Eyes (original) (raw)

Abstract

Background: To evaluate the in vivo corneal changes using in vivo confocal microscopy (IVCM) and anterior segment optical coherence tomography (AS-OCT) in patients with Fuchs' dystrophy who underwent Descemet stripping automated endothelial keratoplasty (DSAEK) and the relationship between these changes and the postoperative visual recovery up to 1-year follow-up. Methods: Before DSAEK and 1 day, 3, 6 and 12 months after surgery 31 patients (39 pseudophakic eyes) underwent a complete ophthalmological evaluation including best corrected visual acuity (BCVA), IVCM (subepithelial haze, interface haze, graft thickness) and AS-OCT (graft thickness). Results: Graft thickness measurements by AS-OCT were strongly correlated to those obtained using IVCM at every follow-up stage (intraclass correlation coefficient = 0.95 to 0.97 between 3 and 12 months, P < 0.001 for all coefficients). No correlation between BCVA and graft thickness measured by AS-OCT at any follow-up stage was found, while at 3 and 6 postoperative months the correlations between BCVA and preoperative subepithelial haze (r = 0.61, P < 0.001 and r = 0.46, P = 0.002), interface haze (r = 0.51, P < 0.001 and r = 0.46, P = 0.003), postoperative subepithelial haze (r = 0.43, P = 0.004 and r = 0.39, P = 0.001) were significant. Conclusions: The study confirmed corneal subepithelial haze and interface haze as important factors limiting visual acuity after DSAEK, while graft thickness was not related to BCVA.

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References (38)

  1. Nanavaty MA, Wang X, Shortt AJ. Endothelial keratoplasty versus penetrating keratoplasty for Fuchs endothelial dystrophy. Cochrane Database Syst Rev. 2014;2:CD008420.
  2. Gorovoy MS. Descemet-stripping automated endothelial keratoplasty. Cornea. 2006;25:886-9.
  3. Price Jr FW, Price MO. Descemet's stripping with endothelial keratoplasty in 200 eyes: early challenges and techniques to enhance donor adherence. J Cataract Refract Surg. 2006;32:411-8.
  4. Koenig SB, Covert DJ, Dupps Jr WJ, Meisler DM. Visual acuity, refractive error, and endothelial cell density six months after Descemet stripping and automated endothelial keratoplasty (DSAEK). Cornea. 2007;26:670-4.
  5. Koenig SB, Covert DJ. Early results of small-incision Descemet's stripping and automated endothelial keratoplasty. Ophthalmology. 2007;114:221-6.
  6. Chamberlain W, Omid N, Lin A, Farid M, Gaster RN, Steinert RF. Comparison of corneal surface higher-order aberrations after endothelial keratoplasty, femtosecond laser-assisted keratoplasty, and conventional penetrating keratoplasty. Cornea. 2012;3:6-13.
  7. Bahar I, Kaiserman I, McAllum P, Slomovic A, Rootman D. Comparison of posterior lamellar keratoplasty techniques to penetrating keratoplasty. Ophthalmology. 2008;115:1525-33.
  8. Chen ES, Terry MA, Shamie N, Hoar KL, Friend DJ. Descemet-stripping automated endothelial keratoplasty: six-month results in a prospective study of 100 eyes. Cornea. 2008;27:514-20.
  9. Jun B, Kuo AN, Afshari NA, Carlson AN, Kim T. Refractive change after Descemet stripping automated endothelial keratoplasty surgery and its correlation with graft thickness and diameter. Cornea. 2009;28:19-23.
  10. Scorcia V, Matteoni S, Scorcia GB, Scorcia G, Busin M. Pentacam assessment of posterior lamellar grafts to explain hyperopization after Descemet's stripping automated endothelial keratoplasty. Ophthalmology. 2009;116:1651-5.
  11. Holz HA, Meyer JJ, Espandar L, Tabin GC, Mifflin MD, Moshirfar M. Corneal profile analysis after Descemet stripping endothelial keratoplasty and its relationship to postoperative hyperopic shift. J Cataract Refract Surg. 2008;34:211-4.
  12. Hindman HB, Huxlin KR, Pantanelli SM, Callan CL, Sabesan R, Ching SS, et al. Post-DSAEK optical changes: a comprehensive prospective analysis on the role of ocular wavefront aberrations, haze, and corneal thickness. Cornea. 2013;32:1567-77.
  13. Terry MA, Shamie N, Chen ES, Phillips PM, Hoar KL, Friend DJ. Precut tissue for Descemet's stripping automated endothelial keratoplasty: vision, astigmatism, and endothelial survival. Ophthalmology. 2009;116:248-56.
  14. Rao SK, Leung CK, Cheung CY, Afshari NA. Descemet stripping endothelial keratoplasty: effect of the surgical procedure on corneal optics. Am J Ophthalmol. 2008;145:991-6.
  15. Hwang RY, Gauthier DJ, Wallace D, Afshari NA. Refractive changes after Descemet stripping endothelial keratoplasty: a simplified mathematical model. Invest Ophthalmol Vis Sci. 2011;52:1043-54.
  16. Muftuoglu O, Prasher P, Bowman RW, McCulley JP, Mootha VV. Corneal higher-order aberrations after Descemet's stripping automated endothelial keratoplasty. Ophthalmology. 2010;117:878-84.
  17. Seery LS, Nau CB, McLaren JW, Baratz KH, Patel SV. Graft thickness, graft folds, and aberrations after Descemet stripping endothelial keratoplasty for fuchs dystrophy. Am J Ophthalmol. 2011;152:910-6.
  18. Phillips PM MD, Phillips LJ, Maloney CM. Preoperative graft thickness measurements do not influence final BSCVA or speed of vision recovery after descemet stripping automated endothelial keratoplasty. Cornea. 2013;32:1423-7.
  19. Price MO, Price Jr FW. Descemet's stripping with endothelial keratoplasty: comparative outcomes with microkeratome dissected and manually dissected donor tissue. Ophthalmology. 2006;113:1936-42.
  20. Daoud YJ, Munro AD, Delmonte DD, Stinnett S, Kim T, Carlson AN, et al. Effect of cornea donor graft thickness on the outcome of Descemet stripping automated endothelial keratoplasty surgery. Am J Ophthalmol. 2013;156:860-6.
  21. Ivarsen A, Hjortdal J. Recipient corneal thickness and visual outcome after Descemet's stripping automated endothelial keratoplasty. Br J Ophthalmol. 2014;98:30-4.
  22. Kobayashi A, Mawatari Y, Yokogawa H, Sugiyama K. In vivo laser confocal microscopy after Descemet stripping with automated endothelial keratoplasty. Am J Ophthalmol. 2008;145:977-85.
  23. Baratz KH, McLaren JW, Maguire LJ, Patel SV. Corneal haze determined by confocal microscopy 2 years after Descemet stripping with endothelial keratoplasty for Fuchs corneal dystrophy. Arch Ophthalmol. 2012;130:868-74.
  24. Ahmed KA, McLaren JW, Baratz KH, Maguire LJ, Kittleson KM, Patel SV. Host and graft thickness after Descemet stripping endothelial keratoplasty for Fuchs endothelial dystrophy. Am J Ophthalmol. 2010;150:490-7.
  25. Di Pascuale MA, Prasher P, Schlecte C, Arey M, Bowman RW, Cavanagh HD, et al. Corneal deturgescence after Descemet stripping automated endothelial keratoplasty evaluated by Visante anterior segment optical coherence tomography. Am J Ophthalmol. 2009;148:32-7.
  26. Yoo SH, Kymionis GD, Deobhakta AA, Ide T, Manns F, Culbertson WW, et al. One-year results and anterior segment optical coherence tomography findings of Descemet stripping automated endothelial Keratoplasty combined with phacoemulsification. Arch Ophthalmol. 2008;126:1052-5.
  27. Pescosolido N, Komaiha C, Dapoto L, Lenarduzzi F, Nebbioso M. Corneal haze in course of Fuchs' endothelial dystrophy. Clin Ter. 2012;163:e169-71.
  28. Mustonen RK, McDonald MB, Srivannaboon S, Tan AL, Doubrava MW, Kim CK. In vivo confocal microscopy of Fuchs' endothelial dystrophy. Cornea. 1998;17:493-503.
  29. Erie JC, McLaren JW, Patel SV. Confocal microscopy in ophthalmology. Am J Ophthalmol. 2009;148:639-46.
  30. Espana EM, Huang B. Confocal microscopy study of donor-recipient interface after Descemet's stripping with endothelial keratoplasty. Br J Ophthalmol. 2010;94:903-8.
  31. McLaren JW, Nau CB, Patel SV, Bourne WM. Measuring corneal thickness with the ConfoScan 4 and z-ring adapter. Eye Contact Lens. 2007;33:185-90.
  32. Dickman MM, Cheng YY, Berendschot TT, van den Biggelaar FJ, Nuijts RM. Effects of graft thickness and asymmetry on visual gain and aberrations after Descemet stripping automated endothelial keratoplasty. JAMA Ophthalmol. 2013;131:737-44.
  33. Dapena I, Ham L, Melles GRJ. Endothelial keratoplasty: DSEK/DSAEK or DMEK -the thinner the better? Curr Opin Ophthalmol. 2009;20:299-307.
  34. Van Dijk K, Ham L, Tse WHW, Liarakos VS, Quilendrino R, Yeh RY, et al. Near complete visual recovery and refractive stability in modern corneal transplantation: Descemet membrane endothelial keratoplasty (DMEK). Contact Lens Anterior Eye. 2013;36:13-21.
  35. Shinton AJ, Tsatsos M, Konstantopoulos A, Goverdhan S, Elsahn AF, Anderson DF, et al. Impact of graft thickness on visual acuity after Descemet's stripping endothelial keratoplasty. Br J Ophthalmol. 2012;96:246-9.
  36. Patel SV, McLaren JW. In vivo confocal microscopy of Fuchs endothelial dystrophy before and after endothelial keratoplasty. JAMA Ophthalmol. 2013;131:611-8.
  37. Heinzelmann S, Böhringer D, Maier PC, Reinhard T. Correlation between visual acuity and interface reflectivity measured by pentacam following DSAEK. Acta Ophthalmol. 2014;92:e1-4.
  38. Ferrari G, Reichegger V, Ludergnani L, Delfini E, Macaluso C. In vivo evaluation of DSAEK interface with scanning-laser confocal microscopy. BMC Ophthalmol. 2012;12:32.