Refractive Change After Descemet Stripping Automated Endothelial Keratoplasty Surgery and Its Correlation With Graft Thickness and Diameter

Abstract Background Remnant interface fluid following Descemet stripping automated endothelial keratoplasty (DSAEK) is associated with postoperative detachments. The aim of this study was to assess outcomes of intraoperative optical coherence tomography (iOCT) guided meticulous peripheral corneal sweeping for removal of interface fluid during ultra-thin (UT) DSAEK. Methods This retrospective study included all eyes underwent iOCT guided UT-DSAEK from October 2016 to February 2018 at the Hanusch Hospital, Vienna, Austria. Peripheral meticulous corneal sweeping was performed to remove excess fluid. Central graft thickness (CGT) was measured prior to surgery, after graft bubbling and after corneal sweeping. Remnant interface fluid rates were compared between eyes that underwent rebubbling and those that did not. Results Overall, 28 eyes of 28 patients with a mean age of 73.9 ± 10.0 years were included. An iOCT guided meticulous peripheral sweeping was performed in 89.3% (n = 25) of the cases. Following 84% (n = 21) of the peripheral sweeping performed, remnant fluid was no longer identified. Following peripheral sweeping the interface fluid height was reduced from 17.31 ± 15.96 μm to 3.46 ± 9.52 μm (p < 0.001) and CGT was reduced by 7% (p < 0.001). Rebubbling was performed in 17.9% (n = 5) of the cases. The rebubbling group had a greater proportion of patients that had remnant fluid identified with iOCT at the end of surgery despite meticulous peripheral sweeping (60.0% versus 4.4%, p = 0.01). Conclusion The iOCT identified subclinical remnant fluid in nearly 90% of UT-DSAEK cases. An iOCT guided peripheral corneal sweeping led to resolution of interface fluid in a majority of cases. Eyes with persistent remnant fluid despite peripheral corneal sweeping are more likely to require subsequent rebubbling.

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Refractive change and stability after Descemet membrane endothelial keratoplasty

Journal of Cataract & Refractive Surgery ◽

10.1016/j.jcrs.2011.02.033 ◽

2011 ◽

Vol 37 (8) ◽

pp. 1455-1464 ◽

Cited By ~ 69

Author(s):

Lisanne Ham ◽

Isabel Dapena ◽

Kyros Moutsouris ◽

Chandra Balachandran ◽

Laurence E. Frank ◽

...

Keyword(s):

Endothelial Keratoplasty ◽

Descemet Membrane Endothelial Keratoplasty ◽

Descemet Membrane ◽

Refractive Change

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Outcomes of ultrathin Descemet stripping automated endothelial keratoplasty (UT-DSAEK) performed in eyes with failure of primary Descemet membrane endothelial keratoplasty (DMEK)

British Journal of Ophthalmology ◽

10.1136/bjophthalmol-2017-311834 ◽

2018 ◽

Vol 103 (5) ◽

pp. 599-603 ◽

Cited By ~ 2

Author(s):

Shmuel Graffi ◽

Pia Leon ◽

Yoav Nahum ◽

Shay Gutfreund ◽

Rossella Spena ◽

...

Keyword(s):

Intraoperative Complications ◽

Tertiary Care ◽

Case Series ◽

Care Hospital ◽

Endothelial Keratoplasty ◽

Descemet Membrane Endothelial Keratoplasty ◽

Visual Rehabilitation ◽

Descemet Membrane ◽

Graft Thickness ◽

Iol Exchange

AimTo evaluate the outcomes of ultrathin Descemet stripping automated endothelial keratoplasty (UT-DSAEK) performed in eyes after failure of primary Descemet membrane endothelial keratoplasty (DMEK).MethodsThis was a retrospective, non-comparative interventional case series done in a tertiary care hospital. The study group included 21 eyes of patients which underwent UT-DSAEK following the failure of primary DMEK. Outcome measures included best spectacle-corrected visual acuity (BSCVA) and endothelial cell density (ECD) both recorded 6 and 12 months postoperatively as well as central graft thickness (CGT) measured 6 months after UT-DSAEK.ResultsWhen considering only eyes without comorbidities (17 of 21), 12 months after UT-DSAEK, BSCVA was ≥20/25 in 12/13 (92%) eyes and ≥20/20 in 4/13 (30%) eyes. Mean ECD loss rate was 38.9% at 12 months postoperatively (range 8%–57%). Six months postoperatively, CGT averaged at 81±34 µm (range 34–131 µm). No intraoperative complications were recorded. Postoperatively, one patient (no. 8) had graft wrinkles that were fixed 2 days following UT-DSAEK. Four patients have developed intraocular lens (IOL) opacification, and two of them underwent IOL exchange. No other postoperative complications were recorded.ConclusionsUT-DSAEK is instrumental in the management of primary DMEK graft failure, allowing visual rehabilitation which is comparable with that of repeat DMEK.

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Graft thickness and visual acuity after automated endothelial keratoplasty

Acta Ophthalmologica ◽

10.1111/j.1755-3768.2012.t100.x ◽

2012 ◽

Vol 90 ◽

pp. 0-0

Author(s):

A RABOT ◽

V SOLER ◽

P FOURNIE

Keyword(s):

Visual Acuity ◽

Endothelial Keratoplasty ◽

Graft Thickness

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Comparison of Graft Thickness Measured by an Eye Bank With Graft Thickness Measured After Descemet Stripping Automated Endothelial Keratoplasty

Cornea ◽

10.1097/ico.0000000000001855 ◽

2019 ◽

Vol 38 (4) ◽

pp. 403-408 ◽

Cited By ~ 3

Author(s):

Sepehr Feizi ◽

Siamak Delfazayebaher ◽

Ali Masoudi ◽

Zahra Babamohamadi ◽

Mohammad Ali Javadi

Keyword(s):

Endothelial Keratoplasty ◽

Eye Bank ◽

Graft Thickness

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Graft Thickness, Graft Folds, and Aberrations After Descemet Stripping Endothelial Keratoplasty for Fuchs Dystrophy

American Journal of Ophthalmology ◽

10.1016/j.ajo.2011.05.003 ◽

2011 ◽

Vol 152 (6) ◽

pp. 910-916 ◽

Cited By ~ 36

Author(s):

Loren S. Seery ◽

Cherie B. Nau ◽

Jay W. McLaren ◽

Keith H. Baratz ◽

Sanjay V. Patel

Keyword(s):

Endothelial Keratoplasty ◽

Descemet Stripping Endothelial Keratoplasty ◽

Graft Thickness ◽

Fuchs Dystrophy

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Impact of graft thickness on visual acuity after Descemet's stripping endothelial keratoplasty

British Journal of Ophthalmology ◽

10.1136/bjophthalmol-2011-300462 ◽

2011 ◽

Vol 96 (2) ◽

pp. 246-249 ◽

Cited By ~ 40

Author(s):

Anthony J Shinton ◽

Michael Tsatsos ◽

Aris Konstantopoulos ◽

Srini Goverdhan ◽

Ahmad F Elsahn ◽

...

Keyword(s):

Visual Acuity ◽

Endothelial Keratoplasty ◽

Descemet’S Stripping Endothelial Keratoplasty ◽

Graft Thickness

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Long-term observation of graft thickness and shape in Descemet stripping and automated endothelial keratoplasty

European Journal of Ophthalmology ◽

10.1177/1120672119826004 ◽

2019 ◽

Vol 30 (1) ◽

pp. 155-161

Author(s):

Yi-Ching Hsieh ◽

Chun-Chi Chiang ◽

Yi-Yu Tsai

Keyword(s):

Optical Coherence Tomography ◽

Retrospective Study ◽

Anterior Segment ◽

Endothelial Keratoplasty ◽

Graft Thickness ◽

Asymmetrical Shape ◽

Optical Zone ◽

Long Term Observation ◽

Common Shape

Purpose: To evaluate the thickness and shape of the posterior lamellar graft in Descemet stripping and automated endothelial keratoplasty after long-term observation. Methods: All patients who underwent Descemet stripping and automated endothelial keratoplasty including simple and triple Descemet stripping and automated endothelial keratoplasty between August 2009 and May 2014 were enrolled in this retrospective study. To assess postoperative thickness and shape of the Descemet stripping and automated endothelial keratoplasty graft, images of the graft taken at the center (C), mid-periphery at 4 mm optical zone (P1), and periphery at 6 mm optical zone (P2) at 1, 2, and 3 years postoperatively were obtained using anterior segment optical coherence tomography. Results: C:P1 was 0.96, 0.96, and 0.95 at 1, 2, and 3 years postoperatively, respectively. C:P2 was 0.85, 0.84, and 0.83 at 1, 2, and 3 years postoperatively, respectively. There was a greater thinning of the central graft thickness compared with the peripheral graft thickness. The shapes of the posterior lamellar graft were variable, such as concave, asymmetrical, planar, irregular, and convex meniscus shapes. The most common shape was asymmetrical shape at 1 year postoperatively and concave at 2 and 3 years postoperatively. The most common shape of the posterior lamellar grafts was asymmetrical shape (38.18%) at 1 year postoperatively, followed by concave (34.54%), planar (20.00%), irregular (5.45%), and convex (1.81%) shapes. The most common shape was concave shape (44.44% and 57.14% for 2 and 3 years postoperatively, respectively), followed by asymmetrical (27.77% and 17.85%, respectively), planar (16.66% and 17.85%, respectively), and irregular (11.11% and 7.14%, respectively) shapes. Conclusion: In our study, concave meniscus was not the only observed shape of the graft. The shape and thickness of the graft did not stabilize even 3 years postoperatively in some patients. These findings should be taken into consideration in a combination of Descemet stripping and automated endothelial keratoplasty and cataract surgery.

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