Predictive value of optical coherence tomography in graft attachment after Descemet membrane endothelial keratoplasty

Abstract

AbstractPurpose To evaluate the predictive value of early anterior segment optical coherence tomography (AS‐OCT) on graft adherence or detachment after Descemet membrane endothelial keratoplasty (DMEK).Methods Retrospective study of prospectively collected data at a tertiary referral center. 87 eyes of 87 patients out of a consecutive series of 142 DMEK surgeries were included in the study AS‐OCT was performed within the first hour after DMEK, and at 1‐ week, 1‐month, 3‐months and 6‐months, and for each time interval detachments were classified as ‘none’, ≤1/3 detachment, >1/3 detachment of the total graft surface area, or ‘complete’ detachment. Throughout the study no re‐bubbling procedures were performed. The main outcome measure was graft adherence at various postoperative time intervals.Results 1‐hour AS‐OCT scans were more accurate at predicting the final 6‐month graft adherence status than those at 1‐week or 1‐month. Grafts showing complete attachment or <1/3 detachment at 1‐hour, remained stable or improved in 73% of the cases at 1‐week, 82% at 1‐month, 86% at 3‐months, and 90% at 6‐months, respectively. All grafts attached at 1‐week, remained attached at 6‐months. Graft detachments of >1/3 at 1‐hour showed re‐attachment at 6 months in 25% of the cases, while 67.5% of the cases showed a persistent detachment of >1/3 at 6 months and 12.5% a complete detachment.Conclusion The 1‐hour AS‐OCT showed best predictive value on 6‐month graft adherence status. The combined information of the 1‐hour and 1‐week AS‐OCT may facilitate decision making on surgical re‐intervention after DMEK.