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Sikandar Aziz, Javier Cabrerizo; In vivo confocal microscopy assessment of the Descemet-stromal interface after Descemet's membrane endothelial keratoplasty.. Invest. Ophthalmol. Vis. Sci. 2017;58(8):3538.
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© ARVO (1962-2015); The Authors (2016-present)
Descemet Membrane Endothelial Keratoplasty (DMEK) provides no clinically evident interface reaction between the donor Descemet membrane and the recipient stroma. However, the microscopical changes that are implicated in the graft-stroma attachment in the early postoperative period remain poorly understood. This study aims to identify and characterize ultrastructural changes in the posterior stroma and donor Descemet membrane of potential clinical relevance in the DMEK healing process.
We report a single-center retrospective cohort study. A total of 12 eyes of 6 patients (3 men, 3 women) who recently underwent unilateral DMEK were included. Mean age was 72 ± 9 years. Patients who had previously undergone other types of keratoplasty were excluded. We performed in-vivo laser confocal microscopy (II Rostock Corneal Module (HRTII), Heidelberg, Germany) sequential images of different corneal regions (center and mid-peryphery) at different postoperative time points (1 week, 4 weeks, 12 weeks). Selected images were evaluated qualitatively and quantitatively and relevant histological findings were characterized.
After DMEK changes in the posterior stroma were observed in all six cases, at the donor-recipient interface. Stromal hiperreflectivity and endothelial stroma (represented by hiperreflectivity changes in the endothelium) were found to be significantly higher in the DMEK treated eyes, compared to the other eye of the same subject. Furthermore, quiescent keratinocites and structured needle-shaped stromal fibers were observed in all DMEK treated eyes.
Our study characterized specific changes in the posterior stroma and donor Descemet membrane present in the early postoperative phases after DMEK. Those changes may play a crucial role in the postoperative mechanism that promote graft attachment.
This is an abstract that was submitted for the 2017 ARVO Annual Meeting, held in Baltimore, MD, May 7-11, 2017.
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