Posters

Assessing Descemet’s stripping automated endothelial keratoplasty in complex cases followed up with optical coherence tomography

Poster Details

First Author: C. Bonzano ITALY

Co Author(s): D. Musetti   R. Scotto   C. Cutolo   P. Pagani   C. Traverso        

Abstract Details

Purpose:

To assess the predictive value of early Anterior Segment Optical Coherence Tomography (AS-OCT) findings on graft adherence after Descemet’s Stripping Automated Endothelial Keratoplasty (DSAEK) performed in complex eyes.

Setting:

Clinica Oculistica, Di.N.O.G.M.I. University of Genoa and IRCCS Azienda Ospedaliera Universitaria San Martino IST.

Methods:

Forty-one consecutive DSAEK in complex eyes, performed by a single surgeon (C.E.T.), were analyzed. The inclusion criterion was a history of one or more surgical procedures, i.e. trabeculectomy, glaucoma drainage device (GDD, Baerveldt®) implantation, penetrating keratoplasty (PK), aphakia with anterior chamber intraocular lens (AC-IOL) implantation, AC-IOL + GDD, PK + GDD, PK + AC-IOL + GDD, respectively. Complexity included long-standing severe corneal edema. Graft adherence/detachment was assessed using AS-OCT on day 1 (early AS-OCT), week 1 postoperatively and again at 1, 3 and 6 months. Grading: complete attachment, one sector peripheral detachment (1S.P.D.), more than one sector peripheral detachment (>1S.P.D.).

Results:

Of the 41 consecutive complex eyes analyzed, thirty-three eyes (80%) had severe corneal edema preoperatively. At day 1, 8 grafts (20%) were completely attached in the AS-OCT scan and 33 (80%) showed some degree of peripheral detachment. Twenty-one (64%) of the partially detached cases presented 1S.P.D. and 12 (36%) had >1S.P.D. At 6 months, completely attached grafts were stable. Nineteen eyes with 1S.P.D. (90%) showed improved graft adhesion; 2 (10%) were unchanged. Of the 12 cases with >1S.P.D.: 9 (75%) were stable, 2 (17%) detached completely while and 1 (8%) improved.

Conclusions:

AS-OCT is a non-invasive imaging technique and therefore suited to monitor DSAEK graft adhesion in complex eyes. Findings at day 1 yielded a good predictive value of graft adherence at 6 months. Therefore, early AS-OCT scans do, indeed, facilitate decision-making with regards to further surgical procedures in complex eyes.

Financial Disclosure:

None