Donor tissue detachment after descemet stripping automated endothelial keratoplasty (DSAEK): a 35 mhz probe ubm study

Abstract

Abstract Purpose To evaluate the UBM role in cases of donor lamella detachment after DSAEK using a 35 MHz probe and immersion technique. Methods Two patients ,a 68 yo woman and a 70 yo man,underwent to uncomplicated DSAEK for bullous keratopathy.An initial corneal clearing was observed in the first 48 hours followed by a progressive increase of corneal oedema causing a difficult evaluation of donor lamella and anterior chamber structures. In one case,an acute glaucoma occurred.Ecographic evaluation was performed with 35 MHz probe and immersion technique(Hi Scan Ecographer,Optikon 2000,Rome,Italy ).Six scans centered on the cornea and 30 degrees angled were aquired in order to obtain a topographic map. Results UBM allowed to distinguish between two morphological patterns according to donor lamella’s position: partial detachment(PD)(double chamber appearance without lammela’s dislocation)or total detachment(TD)if associated to donor graft dislocation. In the case complicated by acute glaucoma , a pupillary block caused by a PD was seen.The main UBM findings were:donor lamella tickening with high hyporeflectivity of recipient stroma due to oedema . Conclusion The donor lamella detachment is the main complication of DSAEK procedure . Posterior lamella and anterior chamber evaluation may be difficult in this cases due to corneal oedema.UBM allows to distinguish between partial and total detachment of posterior lamella and main related complications;trought a topographic map,it offers informations usephul to the reattachment surgical strategy.