Scheimpflug Rotational Camera , Confocal Microscopy and Optical Coherence Tomography Analysis of Descemet Membrane Endothelial Keratoplasty in Fuchs Disease

Abstract

Purpose: : To report morphological analysis of 3 imaging devices of new surgical procedure of endothelial keratoplasty in Fuchs diseases.

Methods: : Prospective, noncomparative, interventional case series about nineteen eyes of 19 patients with corneal edema Fuchs dystrophy.The recipient's Descemet's membrane was excised by performing a descemetorhexis through a 3.2 mm corneal incision . In all cases the endothelial transplant was harvested using a lamellar manual dissection, rolled up in a cataract insertion device and injected into the anterior chamber.A temporary air - gas bubble was injected into the anterior chamber for donor tissue adherence.Preoperative and postoperative best spectacle-corrected visual acuity (BSCVA), manifest refraction (MR) astigmatism, pachymetry, endothelial cell density (ECD), Scheimpflug analysis (Pentacam ,Oculus, Wetzlar, Germany), in vivo confocal microscopy with the Heidelberg Retinal Tomograph II Rostock Corneal Module (HRT II-RCM) and Visante optical coherence tomography of the anterior segment (AS-OCT, Carl Zeiss Meditec, Dublin, California, USA) were evaluated over 9 months after surgery.

Results: : At the end of the follow-up 15 grafts of 15 remained transparent and grafts were healed in good position.At 9 months, the mean uncorrected visual acuity is 20/40 and the best-corrected visual acuity is 20/32. The average MR astigmatism is 0,6 +/- 0,3 diopters (D) and the spherical equivalent is 0,4 +/-0,4 D. The mean ultrasonic pachymetry is 548 +/-34 microns.Scheimplflug analysis show a mean keratometry of 43 +/-1,6 D., a astigmatism of the anterior cornea of 1,1 +/-0,4 D. and 0,4 +/-0,3 D for the posterior cornea, the mean volume of the cornea is 64 +/-4 mm³.The average ECD at 9 months was 1300 +/-400 cells/mm² .Confocal microscopy analysis was able to evaluate ECD, show the descemethorexis and the contact between graft and pathologic endothelium.We were able to measure mean central pachymetry 550 +/-50 microns and mean central thickness graft 77 +/-17 microns in all cases, thanks to Visante images.

Conclusions: : This procedure, with its absence of corneal surface incisions and sutures, is a safe procedure that preserves the normal corneal topography, minimizes astigmatism and corneal power changes. New devices of anterior segment analyse are useful to investigate corneal power and endothelial function particularly after endothelial keratoplasty.

Keywords: cornea: endothelium • transplantation • imaging/image analysis: clinical