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Ewa Anna Meyer, Ursula Schlötzer-Schrehardt, Theofilos Tourtas, Friedrich E Kruse, Julia Marina Weller; Ultrastructural abnormalities of corneal grafts influencing outcome after Descemet membrane endothelial keratoplasty. Invest. Ophthalmol. Vis. Sci. 2016;57(12):1210. doi: https://doi.org/.
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© ARVO (1962-2015); The Authors (2016-present)
To investigate, if ultrastructural alterations in Descemet membrane (DM) grafts, indicative of disturbances in corneal endothelial function, are correlated with postoperative clinical outcome after Descemet membrane endothelial keratoplasty (DMEK).
In a retrospective single-center consecutive series, 112 residual DM specimens obtained after DM stripping were examined by transmission electron microscopy. Main postoperative outcome parameters analyzed were detachment rate, graft failure rate, best corrected visual acuity (BCVA), endothelial cell density (ECD), and central corneal thickness (CCT). Examination dates were on the day before DMEK, and 1, 3, 6, and 12 months after surgery.
Most specimens (86%) showed a normal ultrastructure of DM. Structural alterations were observed in 16/112 (14%) specimens, comprising abnormal inclusions of long-spacing and fibrillary collagen as well as proteoglycans, deposition of a posterior collagenous layer and pseudoexfoliative material, and formation of guttae. Evaluation of postoperative clinical parameters revealed an increased graft detachment rate and repeated air injections in the group having received abnormal DM grafts (11/16, 69%) compared to the group having received normal DM grafts (42/96, 44%); the difference was marginally significant (p=0.056). However, there were a significantly greater proportion of graft failures in the abnormal DM group (6/16, 38%) than in the normal DM group (7/96, 7%) (p=0.007). Although CCT increased up to 850 µm in the eyes with primary graft failure before re-grafting there was no significant difference in CCT and ECD between groups at any time-point. This can be attributed to different time points at which graft failures occured.
This study provided evidence of a correlation between ultrastructural alterations of donor DM grafts, reflecting pre-operative disturbances in endothelial function, and the graft failure rate after DMEK. Thus, clinical outcome after DMEK may be not only affected by surgical and postoperative factors but also by intrinsic, graft-specific features.
This is an abstract that was submitted for the 2016 ARVO Annual Meeting, held in Seattle, Wash., May 1-5, 2016.
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