The Use of Anterior Segment Optical Coherence Tomography in Descemet’s Stripping Endothelial Keratoplasty to Predict Ultimate Success or Failure in the Early Post-Operative Period

Abstract

 

Purpose:

 

To determine the utility of Slit Lamp Optical Coherence Tomography (SL-OCT) to predict donor lenticle viability in Descemet’s Stripping Endothelial Keratoplasty (DSEK).

 

Methods:

 

58 DSEK’s performed by two surgeons (JAS and DCR) from March 1 2006 until September 2007 that had SL-OCT were reviewed. Lenticle and host cornea thickness was measured by SL-OCT when possible at 1 week, 1 month, 2 months, and greater than 2 months depending on the post-operative follow-up. Successful DSEK surgery was defined as having an attached, clear and compact lenticle without clinical evidence of endothelial decompensation, (≥2+) stromal thickening, or opacification.

 

Results:

 

58 DSEK eyes had at least one or more SL-OCT performed. 13 eyes had SL-OCT at one week, 10 were eventually successful and 3 were failures. Of the 10 successes the donor lenticle thickness ranged from165µ -312µ. The donor lenticle range for the 3 failures was 532µ -687µ.17 eyes that had SL-OCT at one month, 13 were ultimately successful and four were failures. Of the 13 successful DSEKs, 12/13 (92%) had a donor lenticle thickness of 350µ or less as measured by SL-OCT at one month. Of the 4 failed DSEKs, all had donor lenticle thickness of 375µ or more as measured at one month. The lenticle thickness range was 161µ -343µ, with one outlier at 495 in the 13 successful DSEK’s. The lenticle thickness range was 375µ -720 µ in the 4 failed DSEK’s.16 eyes had SL-OCT at two months, 12 were ultimately successful and 4 were failures. The range of lenticle thickness was 172µ -330µ for success and was 410µ-790µ in the failures.

 

Conclusions:

 

SL-OCT may be a valuable tool to predict DSEK success in attached lenticles within the first month of surgery. DSEK lenticle thickness of 350µ or less at one month had a predictability of success of greater than 90%. However further studies using intraoperative pachymetry to determine perioperative lenticle thickness may be required.  

 

Keywords: imaging/image analysis: clinical • cornea: clinical science • imaging methods (CT, FA, ICG, MRI, OCT, RTA, SLO, ultrasound)