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M. A. Di Pascuale, M. Arey, P. Prasher, R. W. Bowman, H. D. Cavanagh, J. P. McCulley, V. V. Mootha; Early Corneal Changes After Descemet’s Stripping Automated Endothelial Keratoplasty (DSAEK) Evaluated by VisanteTM Anterior Segment OCT. Invest. Ophthalmol. Vis. Sci. 2007;48(13):1130.
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To evaluate corneal changes after DSAEK in the immediate post-operative period using the commercially available VisanteTM anterior segment optical coherence tomography. (Carl Ziess Meditec AG, Jena, Germany).
We included 10 consecutive eyes from 10 patients (7 males, 3 females, with mean age of 72.2±9.9 years). Seven patients had preoperative diagnosis of Fuchs’ endothelial dystrophy and 3 patients had bullous keratopathy. In 5 patients, DSAEK alone was performed. Of 4 patients who also had cataract, combined phacoemulsification and IOL implantation with DSAEK were performed in 4 patients while one was left phakic. In each visit, VA, slit lamp examination and anterior segment OCT were performed. Successful DSAEK was defined as an anatomically attached endothelial keratoplasty graft (EKG) with a clear and compact slit lamp cornea appearance.
Mean follow-up time was 2.1 ±1.5 months. The range of pre-operative VA was between HM to 20/50. The range of post-operative VA was between CF at 4 feet to 20/25. Eight patients improved 2 or more lines of BCVA. Successful DSAEK surgery was achieved in all eyes (100%). Complications included one dislocated graft, 1 de-centered graft (both requiring re-bubbling), and 1 case of CME. The pre-operative central and peripheral corneal thickness were 706±81.5 µm and 743±120.3 µm, respectively. In all eyes, central EKG thickness decreased from the first day (220.3±76.2 µm) to the last visit (138.9±44.3 µm) (P= 0.0012). The rate central EKG thinning slows as follows: during the first week (62.7±55.2 µm), followed at 1 month (30.8±38.8 µm), and 3 to 5 months (25.7±17.3 µm). The peripheral EKG thickness decreased from initial (351.7±116.6 µm) to last visit (275.6±172.8 µm), but it was not significant (P 0.3). There was significant decrease in total central corneal thickness from day one (886.6±175.7 µm) to last visit (655.6±66.6 µm), (P=0.0002). The central corneal thickness decreased from the pre-operative visit (706±81.5 µm) to last visit (655.6±66.6 µm), but it was not statistically significant P 0.07. The total peripheral corneal thickness increased from pre-operative 743.5±120.3 µm to last visit 848.1±91.5 µm (P 0.04).
This pilot OCT study revealed that there is a greater thinning of the central EKG compared to peripheral EKG in the post-operative period. The rate of EKG deturgence is greatest in the first week. After DSAEK, central CCT decreases and peripheral corneal thickness increases leading to altered corneal "hour-glass" cross -sectional shape.
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