Abstract
Purpose:
To compare the graft-host interface separation after corneal sweeping and after air fluid exchange using intraoperative spectral domain optical coherence tomography (iOCT) during Descemet Stripping Automated Endothelial Keratoplasty (DSAEK).
Methods:
DSAEK via the technique described by Terry (Terry MA, et al, Ophthalmology 2008; 115;1179-1186) was performed by a single surgeon (JG) in a case series of 23 eyes in 23 patients. Pathology included Fuchs endothelial dystrophy (n=18), previously failed penetrating keratoplasty (n=2), previously failed DSAEK (n=1), pseudophakic bulbous keratopathy (n=1), and Brown-McLean syndrome (n=1). iOCT was executed after corneal sweeping and after air fluid exchange. Graft-host interface separation was digitally quantified in the axial and transverse dimensions and compared after corneal sweeping and after air fluid exchange using a paired t-test.
Results:
Average axial length of the graft-host interface was 34.6 + 28.5 um post-sweep and 59.6 + 92.7 um post-air fluid exchange (p = 0.24). Average transverse length of the graft-host interface was 1.16 + 1.15 mm post-sweep and 1.29 + 1.65 mm post-air fluid exchange (p = 0.62). No visible interface fluid was present in 4 eyes after corneal sweeping and in 5 eyes after air fluid exchange.
Conclusions:
Air fluid exchange in DSAEK does not introduce a significant change in graft-host interface separation compared to the separation present after corneal sweeping. iOCT can evaluate the efficacy of surgical techniques in DSAEK by quantifying graft-host interface separation and confirming graft adherence in real-time.
Keywords: 481 cornea: endothelium •
550 imaging/image analysis: clinical