Abstract
BackgroundDescemet Stripping Automated Endothelial Keratoplasty (DSAEK) allows selective replacement of the endothelium. Post-operative haze and particles can affect the interface quality and, ultimately, visual outcome. In this study, we evaluated DSAEK interface with in vivo laser confocal microscopy (LCM) in order to: (i) correlate interface status with best corrected visual acuity, and (ii) with time from surgery; (iii) correlate interface particle number with best corrected visual acuity. Host-donor interface was imaged and graded using a published reflectivity scale. Particles at the interface were counted.Methods18 eyes of 16 patients (6 males and 10 females); mean age: 74 ± 8.3 years which underwent DSAEK were examined by means of in vivo laser confocal microscopy between 1 and 24 months after surgery. Host-donor interface was imaged and graded using a published reflectivity scale. Particles present at the interface were counted.ResultsInterface reflectivity was 2.17 ± 1.2 and significantly correlated with visual acuity (Spearman correlation coefficient −0.83; P < 0.001), and with time after surgery (Spearman correlation coefficient −0.87; P < 0.001). Visual acuity was 0.67 ± 0.27. The number of particles was 205 ± 117.8; no correlation was found between this number and visual acuity (Spearman correlation coefficient −0.41; P = 0.15).ConclusionDSAEK interface imaged with LCM is helpful in diagnosing poor host-donor interface quality in DSAEK surgery. A good quality interface is related to a better visual acuity. Moreover, the quality of the interface appears to improve as time passes from the surgery. Interface quality is related with visual acuity and improves with time from surgery. LCM should be considered as an added tool in post-DSAEK follow-up of patients. Finally, our study shows that the presence of particles does not influence visual outcome.
Highlights
Descemet Stripping Automated Endothelial Keratoplasty (DSAEK) allows selective replacement of the endothelium
Informed consent was obtained prior to performing confocal microscopy; the study followed the tenets of the Declaration of Helsinki. 18 eyes of 16 patients (6 males and 10 females) who underwent DSAEK surgery due to Fuchs’ dystrophy at the University Hospital of Parma, Italy were included in the study
No correlation was found between the number of particles at the interface and visual acuity (Spearman correlation coefficient −0.41; P = 0.15); Figure 1C
Summary
Descemet Stripping Automated Endothelial Keratoplasty (DSAEK) allows selective replacement of the endothelium. A new generation of in-vivo laser confocal microscopy devices (Heidelberg Retina Tomograph 2 Rostock Cornea Module; Heidelberg Engineering GmbH, Dossenheim, Germany) has become available recently [6,7,8] These instruments provide histology-quality images, without the need to remove, stain and cut the tissue, with a higher axial resolution (4 μm) than that achieved with white-light confocal microscopy (10 μm with ConfoScan 2, Nidek Technologies, Vigonza, Italy). This case series investigates the impact of interface reflectivity and particles on visual acuity in 16 patients at different timepoints. Patients were consecutively enrolled during a two-month time frame
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