In vivo evaluation of DSAEK interface with scanning-laser confocal microscopy

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.

Post-DSAEK Optical Changes

“…47, 48 With repeated prospective images and analyses, we quantified the change in reflectivity and optical quality of regions of interest with time after surgery. Various other methods (confocal microscopy, scatterometry, and Scheimpflug cameras) 9, 11, 13 have been used to assess scatter post-DSAEK. Confocal microscopy utilizes a point illumination light source and a pinhole to minimize out-of-focus signal.…”

Evaluation of interface reflectivity and corneal aberrations following Descemet's stripping automated endothelial keratoplasty

“…[25] This finding is in contrast with what was found in a study from Italy that revealed a good quality interface is related to a better visual acuity and improves with time from surgery. [26]…”

Descemet stripping automated endothelial keratoplasty in Fuchs’ corneal endothelial dystrophy: anterior segment optical coherence tomography and in vivo confocal microscopy analysis

“…Also donor-recipient interface haze has been assumed to affect visual outcome after endothelial keratoplasty [ 13 , 37 , 38 ]; in contrast Espana et al [ 30 ] and Baratz et al [ 23 ] did not find a significant correlation between interface reflectivity and visual outcome. Our data show a correlation between interface haze and postoperative BCVA at 3 and 6 month follow-up, whereas considering the interval changes interface haze reduction positively affected BCVA at 6-to-12 months only.…”