The Association Between Transient Interface Space on Intraoperative OCT and Textural Interface Opacity following DSAEK Surgery

Abstract

 

Purpose

 

To examine the association between transient interface space (TIS) and textural interface opacity (TIO) following DSAEK surgery using intraoperative optical coherence tomography (iOCT).

 

Methods

 

Seventy-six consecutive eyes that underwent DSAEK by one surgeon (JMG) in the PIONEER study, a prospective iOCT study for ophthalmic surgery, were evaluated. iOCT images images were obtained after lenticule apposition with complete air fill and after air-fluid exchange. Postoperative day (POD) 1 OCT images were obtained. Outcome variables included the presence of TIO at the graft-host junction, and the presence of intraoperative and postoperative interface space on OCT.

 

Results

 

Seventy-six eyes from 69 patients were included. The mean age was 71 years (range 31-90). The two most common indications for surgery were Fuchs’ dystrophy (63%) and pseudophakic bullous keratopathy (24%). In 18/76 (23.7%) eyes, TIS was visible on iOCT post air-fluid exchange. TIO was observed in the postoperative period in 18/76 (23.7%). Of the 18 eyes with TIS on iOCT, 14 developed TIO. Of the 4 eyes in the TIS group that did not develop TIO, two had graft dislocations on the first postoperative day, and therefore, resolution of the interface space did not take place. Only 4 of the 18 eyes with TIO did not have TIS on iOCT. TIS on iOCT was associated with a significantly higher risk of postoperative TIO (OR=47.25; p<0.0001). Only 2 of the 18 eyes that had TIS on iOCT had persistence on the POD 1 OCT. There was no significant difference in mean graft thickness between eyes with TIS on iOCT and those without (133 µm vs. 128 µm; t=0.59, p=0.58).

 

Conclusions

 

Eyes with TIS on iOCT are more likely to develop TIO in the postoperative period. It is believed that it is the process of gap closure that results in TIO, possibly secondary to precipitated solutes, retained viscoelastic, or lamellar irregularities caused by delayed adhesion or uneven matching of lamellar fibrils.

 

 

Postoperative slit lamp photo demonstrating textural interface opacity

 

Keywords: 479 cornea: clinical science • 481 cornea: endothelium • 741 transplantation