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C. Macaluso, E. Delfini, V. Reichegger, L. Ludergnani, G. Ferrari; In Vivo Scanning-Laser Corneal Confocal Microscopy Evaluation of Graft Interface in Descemet Stripping Automated Endothelial Keratoplasty (DSAEK). Invest. Ophthalmol. Vis. Sci. 2009;50(13):637.
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. To evaluate corneal morphology assessed with in vivo laser-scanning confocal microscopy in DSAEK patients.
. 33 patients who had undergone DSAEK surgery (1 month to 2 years follow-up), were examined in the operated eye and their BCVA was measured. Scanning-laser confocal microscopy was performed using the Heidelberg Retina Tomograph II with Rostock Cornea Module. Informed consent was obtained before the procedure. The interface between recipient and donor cornea was examined for reflectivity and particles. Measurement of interface haze was obtained by grading from 1 to 4, with 1 meaning low reflectivity (hence good quality interface), as proposed by Kobayashi et al. (2008). As little amorphous particles of various origin have been described at the interface (remnants of necrotic tissue, metal particles, atmospheric dust), they have been counted as number of particles per square mm, exploiting the Heidelberg Retina Tomograph II Rostock Cornea Module software for cell counting
. Interface reflectivity grading in DSAEK grafts resulted significantly correlated with BCVA, with Spearman correlation coefficient 0.79 (p<0.001). Similarly, time passed from surgery in months was significantly correlated with interface reflectivity grading (Spearman correlation coefficient 0.87, p<0.001), suggesting that as months pass after DSAEK surgery, the quality of the interface improves. Moreover, the number of particles detected at the interface level was compared with BCVA, failing to show a significant correlation (Spearman correlation coefficient 0.064).
. A smooth and optically perfect interface area is considered crucial for the successful outcome of lamellar grafts, and this is gaining more importance as lamellar keratoplasty strategies become increasingly popular.We show here that a good quality interface is related to a better visual outcome. Moreover, it was evident that, as the healing process proceeds, the interface gets better as well, in keeping with the notion that visual function progressively improves after surgery. Finally, we have shown that, even if often evident and aesthetically disturbing upon slit-lamp examination and confocal microscopy imaging, interface particles do not appear to significantly affect visual outcome.
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