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J. H. Skalet, N. R. Fram, D. G. Hwang; Use of Anterior Segment Optical Coherence Tomography (ASOCT) to Examine Differential Changes in Graft and Recipient Corneal Thickness After Descemet’s Stripping Automated Endothelial Keratoplasty (DSAEK). Invest. Ophthalmol. Vis. Sci. 2008;49(13):1953.
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To use ASOCT to measure post-operative changes in graft and recipient corneal thickness after DSAEK and to correlate these changes with visual recovery.
Retrospective case review
We reviewed the records of 38 eyes from 33 consecutive patients after DSAEK performed by a single surgeon (DGH) from 2006 to 2007. Changes in total corneal thickness, donor thickness, and recipient thickness after DSAEK were evaluated and analyzed for correlation with changes in best-corrected visual acuity. For this purpose, ASOCT data were analyzed over two time intervals: from 1 week to 1 month and from 1 month to 3-6 months. Data from 14 patients were available for the first interval from 1 week to 1 month. Among these patients, total corneal thickness as measured by ASOCT decreased by a mean of 81.5 microns (p=0.004), recipient corneal thickness decreased by a mean of 65.4 microns (p=0.004), and graft thickness decreased by a mean of 16.1 microns (p=0.126, NS). In these patients, best corrected visual acuity (BCVA) improved by 2.23 lines of Snellen acuity (p = 0.0006) in the 1 week to 1 month interval. Data from 11 patients were available for the 1 month to 3-6 month interval. In the 1 month to 3-6 month interval total corneal thickness decreased by a mean of 15.5 microns (p=0.251, NS), with the recipient thickness decreasing by a mean of 35.5 microns (p=0.121, NS) and the donor tissue increasing by a mean of 20 microns (p= 0.153, NS). The BCVA improved by 0.91 lines of Snellen acuity (p= 0.027) for this interval. There is a trend towards correlation between decrease in total graft thickness and change in BCVA in the 1 week to 1 month interval (p=.082) but not in the 1 month to 3-6 month interval.
ASOCT may be of particular value for following corneal thickness after DSAEK because it can differentially measure graft thickness and recipient thickness. In this small retrospective review, total corneal thickness and recipient corneal thickness each decreased significantly between one week and one month after surgery but did not change significantly between 1 month and 3-6 months after surgery. In the first month after surgery, there was a non-significant trend towards a correlation between a decrease in total corneal thickness and improvement in visual acuity. However, no such correlation was found for the interval between 1 month to 3-6 months, suggesting that further improvements in vision that occur during this time period are unlikely to be related to corneal thickness changes.
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