Posters
Combined specular microscopy and Scheimpflug imaging to improve detection of an impending allograft rejection after DMEK
Poster Details
First Author: L.Baydoun GERMANY
Co Author(s): L. Ham M. Bruinsma D. Santander-García S. Oellerich G. Melles
Abstract Details
Purpose:
To assess if the combined analysis of specular microscopy and Scheimpflug imaging improves detection of an upcoming allograft rejection following Descemet membrane endothelial keratoplasty (DMEK).
Setting:
Retrospective, observational case series.
Methods:
Retrospective analysis of 22 eyes that had developed a clinical proven allograft rejection 28 (±22) months (range: 4-84 months) after DMEK surgery. Specular microscopy and Scheimpflug images routinely made at planned time intervals after DMEK were retrospectively analyzed for changes in endothelial cell morphology (e.g. nuclear activation), cell density (more than10%), and pachymetry (more than 7%), and/or the presence of subclinical keratic precipitates.
Results:
A total of 20/22 eyes (91%) showed detectable changes 0.25-75 months before allograft rejection became clinically manifest: 13/22 (59%) showed both specular microscopy and Scheimpflug imaging changes; 5/22 (23%) only had changes on Scheimpflug imaging, and 2/22 (9%) only had specular microscopy changes. In 18/22 (82%) and 14/22 (64%) eyes subclinical keratic precipitates and endothelial cell morphology changes could be detected, respectively. A total of 11/22 (50%) eyes concurrently showed a more than10% drop in endothelial cell density and 4/22 (18%) had a more than 7% increase in pachymetry.
Conclusions:
Combined analysis of specular microscopy and Scheimpflug imaging may aid in recognizing an upcoming allograft rejection more than 90% of eyes and up to 6 years before rejection becomes clinically manifest. Early recognition of eyes at risk may allow for targeted intensified steroid treatment to prevent endothelial cell damage and surgical re-intervention.
Financial Disclosure:
... receives consulting fees, retainer, or contract payments from a company producing, developing or supplying the product or procedure presented
