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Chiara Bonzano, Donatella Musetti, Riccardo Scotto, Carlo Alberto Cutolo, Paola Pagani, Carlo Enrico Traverso; Assessing Descemet's Stripping Automated Endothelial Keratoplasty in complex cases followed up with Optical Coherence Tomography. Invest. Ophthalmol. Vis. Sci. 2016;57(12):1214.
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© ARVO (1962-2015); The Authors (2016-present)
To assess the predictive value of early Anterior Segment Optical Coherence Tomography (AS-OCT) findings on graft adherence after Descemet's Stripping Automated Endothelial Keratoplasty (DSAEK) performed in complex eyes.
Thirty-seven consecutive DSAEK in complex eyes, performed by a single surgeon (C.E.T.), were analyzed. The main inclusion criterion was a history of one or more surgical procedures, i.e. trabeculectomy, glaucoma drainage device (GDD, Baerveldt®) implantation, penetrating keratoplasty (PK), aphakia with anterior chamber intraocular lens (AC-IOL) implantation, AC-IOL + GDD, PK + GDD, PK + AC-IOL + GDD, respectively. Complexity included severe corneal edema. Uncomplicated cataract extraction with posterior chamber IOL implantation was not a selection criterion. Graft adherence/detachment was assessed using AS-OCT on day 1 (early AS-OCT) and week 1 postoperatively and again at 1, 3 and 6 months. Grading was: complete attachment, one sector peripheral detachment (1S.P.D.), more than one sector peripheral detachment (>1S.P.D.).
Of the 37 consecutive complex eyes analyzed, thirty eyes (81%) had severe corneal edema preoperatively. At day 1, 7 grafts (19%) were completely attached in the AS-OCT scan and 30 (81%) showed some degree of peripheral detachment. Nineteen (63%) of the partially detached cases presented 1S.P.D. and 11 (37%) had >1S.P.D. At 6 months, completely attached grafts were stable. Seventeen eyes with 1S.P.D. (90%) showed improved graft adhesion; 2 (10%) were unchanged. Of the 11 cases with >1S.P.D.: 8 (72%) were stable, 2 (18%) detached completely while and 1 (9%) improved.
AS-OCT is a non-invasive imaging technique and therefore suited to monitor DSAEK graft adhesion in complex eyes. Findings at day 1 yielded a good predictive value of graft adherence at 6 months. Therefore, early AS-OCT scans do, indeed, facilitate decision-making with regards to further surgical procedures in complex eyes.
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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