In Vivo Laser Confocal Microscopy after Non–Descemet's Stripping Automated Endothelial Keratoplasty

Abstract

To investigate in vivo corneal changes in patients with bullous keratopathy who underwent non-Descemet's stripping automated endothelial keratoplasty (nDSAEK) with the use of laser confocal microscopy. Single-center, prospective clinical study. Ten eyes (10 patients; 3 men and 7 women; mean age, 73.5+/-6.6 years [mean+/-standard deviation]) with bullous keratopathy were evaluated in this study. In vivo laser confocal microscopy was performed before and 1, 3, and 6 months after nDSAEK. Selected confocal images of corneal layers were evaluated qualitatively and quantitatively for degree of haze and density of deposits. Before surgery, the following were observed in all patients: corneal epithelial edema, subepithelial haze, keratocytes in a honeycomb pattern, and tiny needle-shaped materials in the stroma. After nDSAEK, subepithelial haze, donor-recipient interface haze, and interface particles were observed in all measurable cases; postoperative haze, interface particles, and needle-shaped materials decreased statistically significantly (P<0.05) over the course of follow-up. In addition, hyperreflective giant interface particles were observed after nDSAEK in all patients. In vivo laser confocal microscopy can identify subclinical corneal abnormalities after nDSAEK such as subepithelial haze, host-recipient interface haze, host stromal needle-shaped materials, and host-recipient interface particles with characteristic giant particles. Further studies with this technology in a large number of patients and long-term follow-up are needed to understand fully the long-term corneal stromal changes after nDSAEK.