Abstract
The purpose of this present study was to investigate predictive clinical factors associated with cystoid macular edema (CME) post Descemet’s stripping automated endothelial keratoplasty (DSAEK) in a large case series. Of 393 consecutive patients who underwent DSAEK at Baptist Eye Institute, Kyoto, Japan between July 2011 and November 2016, 241 patients without CME at the pre- or early-postoperative periods were enrolled. The occurrence of anatomic CME was prospectively examined via optical coherence tomography (OCT). Possible predictive clinical factors for CME were analyzed by multivariate logistic regression analysis. At 1-month post DSAEK, CME occurred in 27 (11.2%) of the 241 patients. Multivariate analysis revealed that primary angle closure glaucoma (PACG) was significantly associated with postoperative CME (odds ratio = 6.4, P = 0.04). The findings of this study revealed that DSAEK in patients with PACG showed a high incidence of CME, thus indicating that they should undergo a careful postoperative observation of the macula via OCT.
Highlights
Bullous keratopathy (BK) is caused by corneal endothelial dysfunction, and leads to corneal swelling that results in a severe loss of vision
Our findings demonstrated that anatomic cystoid macular edema (CME) post Descemet’s stripping automated endothelial keratoplasty (DSAEK) occurred in 11.2% of the enrolled patients
Previous studies conducted in the United States reported that CME post DSAEK was observed in 4% of the patients, which is relatively low compared with our findings[11]
Summary
Bullous keratopathy (BK) is caused by corneal endothelial dysfunction, and leads to corneal swelling that results in a severe loss of vision. We previously reported that in a small group of glaucoma patients who underwent Descemet’s stripping automated endothelial keratoplasty (DSAEK), a high degree of postoperative cystoid macular edema (CME) occurred[2]. It is believed that CME is one of the important factors that induces visual impairment in patients who undergo penetrating keratoplasty (PKP)[9, 10] and endothelial keratoplasty[11, 12]. OCT is so precise that it can be used to diagnose macular diseases in patients undergoing DSAEK in whom CME might be overlooked at the pre- and postoperative periods. The purpose of this present study was to prospectively investigate causative clinical factors in regard to anatomic CME post DSAEK via OCT on a large number of patients by use of multivariate logistic regression analysis
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