Anterior segment optical coherence tomography findings after penetrating keratoplasty

Abstract

AbstractPurposeThis study aimed to assess the contribution of early anterior segment optical coherence tomography (AS‐OCT) after penetrating keratoplasty (PK) by analyzing the appositions of posterior graft‐host junction (GHJ), the tomographic aspect of the graft and the iridocorneal angle (ICA).MethodsA prospective cross‐sectional study including 33 eyes of 32 patients treated with penetrating keratoplasty for various preoperative diagnosis (hydrops, keratoconus, bullous keratopathy, infectious keratitis, ocular trauma, corneal perforation, corneal dystrophy and graft failure). All patients underwent complete ophthalmic examination. Early AS‐OCT (Day 1‐10 postoperative) was done to assess the posterior GHJ, the central corneal thickness, the posterior graft corrugations and the ICA. GHJ patterns were classified as well‐apposed, and mal‐apposed (gap, step, and protrusion). Tomographic features were correlated to best‐corrected visual acuity, and postoperative complications.ResultsThe mean early postoperative central corneal thickness was 643.63 μm. Posterior corrugations were found in 47% of cases, in patients with graft thickness higher than 590 μm. ICA was open except in 4 eyes, among them, two eyes presented anterior synechia, and developed ocular hypertension and graft rejection. A total of 132 graft‐ host cross‐sections were analyzed. 67% were well‐apposed and 33% were mal‐apposed. Steps have been noted in 8 eyes, followed by Gapes in 3 eyes, and Protrusion in 2 cases. Graft‐steps were present in 4 GHJ and all of these patients had keratoconus as a preoperative diagnosis. Among them, one eye underwent surgical revision for persistent graft edema. Host‐steps were detected in 4 mal‐apposed junctions. Best‐corrected visual acuity showed significant difference with the gap and step patterns of malapposition junctions.ConclusionsAS‐OCT is a non‐invasive imaging tool offering high‐resolution corneal imaging. It visualizes the posterior GHJ and ICA beyond a non‐transparent cornea. It is useful for evaluating and monitoring the PK outcomes allowing early detection and management of postoperative complications.