Descemet-Stripping Automated Endothelial Keratoplasty: Six-month Results in a Prospective Study of 100 Eyes (original) (raw)
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Descemet Stripping Automated Endothelial Keratoplasty in Failed Penetrating Keratoplasty Patients
American Journal of Ophthalmology, 2011
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.
Cornea, 2008
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.
PLOS ONE, 2018
Objective Comparison of conventional Penetrating Keratoplasty (PKP), posterior mushroom PKP and Descemet's Stripping Automated Endothelial Keratoplasty (DSAEK) regarding overall graft survival of primary corneal transplants for Fuchs´endothelial dystrophy (FED), best spectacle-corrected visual acuity (BSCVA) and astigmatism. Methods Single centre study using prospectively collected data from the national database for followup of corneal transplants. Main outcome parameters: 10 years graft survival, astigmatism at 24 months, pre-and post-operative BSCVA. Results In total, 721 cases were included: PKP, n = 171; posterior mushroom PKP, n = 91; and DSAEK, n = 459. There was no significant difference in graft survival between PKP, posterior mushroom PKP and the DSAEK technique (log-rank test, P = 0.12). The overall postoperative BSCVA improvement in all treatment groups was significant (paired t-test, P<0.001). Pre-operative BSCVA was better for the DSAEK group (0.68 ± 0.41 logMAR) as compared to the PKP (0.89 ± 0.53) and posterior mushroom PKP group (0.90 ± 0.58); ANOVA, P<0.001. After 24 months, BSCVA was significantly better for the DSAEK group (0.25 ± 0.26 log-MAR) compared to the PKP (0.35 ± 0.29) and posterior mushroom PKP group (0.41 ± 0.42); ANOVA, P<0.001. A significant difference in astigmatism was found (median test, P<0.001) between the DSAEK (1.7 ± 1.1 D), PKP (4.6 ± 2.7 D) and posterior mushroom PKP group (4.5 ± 3.3 D). The significantly lower DSAEK-induced astigmatism was confirmed by vector analysis.
Cornea, 2010
To evaluate the dynamics of cornea and graft thickness after Descemet stripping and endothelial keratoplasty (DSEK) using anterior segment optical coherence tomography (AS-OCT) and to assess the usefulness of AS-OCT in monitoring graft adherence after DSEK. Methods: Eighty-eight eyes from 86 patients underwent DSEK for Fuchs endothelial dystrophy or pseudophakic bullous keratopathy. Central corneal thickness (CCT), endothelial graft thickness (GT), interface fluid presence, graft dislocation, rate of CCT, and GT changes were measured with an AS-OCT during 12-month follow up. Results: The CCT averaged 788 mm preoperatively. On postoperative Day 1, mean CCT was 816 mm and GT was 191 mm. Compared with CCT on the first day, the changes in CCT on 2, 3, and 7 days were statistically nonsignificant. From 1 month to 12 months after DSEK, the CCT significantly diminished (P , 0.001). The CCT dynamics closely correlated with changes of GT and of the recipient's part of cornea. The most rapid rate of thickness decrease was observed between 1 week and 1 month: 5.34 mm/day for the entire cornea and 2.54 mm/day for endothelial disc. Between 1 month and 1 year, the CCT and GT were stable with only a trend toward further decrease. Entrapped fluid at graft/host interface on the first postoperative day was detectable by slit-lamp examination in 14 eyes (16%) and in 28 eyes (32%) in OCT. Conclusion: The recovery of endothelial pump after DSEK takes place between 1 week and 1 month after DSEK. AS-OCT can be practically used for evaluation of the cornea dynamics as well as for the qualitative and quantitative assessment of graft-host interface after DSEK.
American Journal of Ophthalmology, 2009
PURPOSE: To evaluate postoperative corneal deturgescence after Descemet stripping endothelial keratoplasty (DSAEK) using the Visante anterior segment optical coherence tomography (OCT) system (Carl Zeiss Meditec Inc, Dublin, California, USA). • DESIGN: Retrospective case series. • METHODS: We included 21 eyes (9 males and 12 females; mean age ؎ standard deviation, 76.3 ؎ 12 years). The Visante OCT system was used to determine the central and peripheral endothelial keratoplasty graft thickness and total central and peripheral corneal thickness. • RESULTS: Central graft thickness decreased from the first day (243.3 ؎ 92 m) to the last visit (147.8 ؎ 44 m; P ؍ .0001). The rate of central graft thinning slowed during the following intervals: during the first week (47 m), at 1 week to 1 month (40 m), and at 1 to 6 months (25 m), with a mild increase at 6 to 9 months (5 m). Peripheral graft thickness continued to decrease from postoperative day 1 (318.5 ؎ 99 m) to the last visit (196.7 ؎ 50 m; P ؍ .0001). There was a decrease in total central corneal thickness from day 1 (903.8 ؎ 179 m) to the last visit (671 ؎ 93 m; P ؍ .0001). All patients were imaged with the Visante OCT at the first 4 defined postoperative intervals; however, only 9 eyes were imaged at the last interval of 6 to 9 months. • CONCLUSIONS: After DSAEK, there is a greater thinning of the central graft compared with the peripheral graft. The central cornea thickness decreases and peripheral corneal thickness increases. Central corneal graft deturgescence stabilizes by 6 months after surgery. (Am J Ophthalmol 2009;148:32-37.