Combined specular microscopy and Scheimpflug imaging to improve detection of an upcoming allograft rejection after DMEK

Baydoun, Lamis; Bruinsma, Marieke; Santander-García, Diana; Ham, Lisanne; Oellerich, Silke; Melles, Gerrit R.J.

doi:10.1111/aos.14234

Cited by 6 publications

(14 citation statements)

References 28 publications

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“…FED in the donor cornea might have been overlooked by the eye bank, as already suggested by Baydoun and colleagues. 4 However, the fellow donor corneas for patient 2's left eye and patient 3 were used for Descemet stripping endothelial keratoplasty elsewhere, and guttae-like changes were not identified.…”

Section: Discussionmentioning

confidence: 99%

“…The reappearance of guttae or guttae-like changes in the donor endothelium in FED has been considered as artifact or interface deposits, 2 recurrence of the disease, 3 or subclinical allograft rejection. 4 Nevertheless, the presence of such changes has never led to retransplantation. 2 Moreover, the presence of guttae-like changes post DMEK has never been imaged with in vivo confocal microscopy (IVCM) to date.…”

Section: Guttae-like Changes Post Descemet Membrane Endothelial Keratoplastymentioning

confidence: 99%

“…As disease progresses, their number and size increase.The reappearance of guttae or guttae-like changes in the donor endothelium in FED has been considered as artifact or interface deposits, 2 recurrence of the disease, 3 or subclinical allograft rejection. 4 Nevertheless, the presence of such changes has never led to retransplantation. 2 Moreover, the presence of guttae-like changes post DMEK has never been imaged with in vivo confocal microscopy (IVCM) to date.The aim of this study was to analyze guttae-like changes post DMEK and correlate clinical findings with SM and ICVM images in a case series of patients affected by FED.…”

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confidence: 99%

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Guttae-like changes post Descemet membrane endothelial keratoplasty

Viola

Neri

Cian

et al. 2021

Canadian Journal of Ophthalmology

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Guttae-like changes post Descemet membrane endothelial keratoplastyDescemet membrane endothelial keratoplasty (DMEK) is a selective keratoplasty of the Descemet membrane (DM) and endothelium. DMEK is one of the most recent and effective keratoplasty techniques to treat Fuchs endothelial dystrophy (FED). 1 Isolated and not confluent, guttae are considered the main clinical sign of early-stage FED. Guttae are thought to be made of extracellular matrix depositions at the inner level of the DM and are easily detectable on slit-lamp examination. 2 On specular microscopy (SM), guttae are represented as dark spots within the endothelial layer. As disease progresses, their number and size increase.The reappearance of guttae or guttae-like changes in the donor endothelium in FED has been considered as artifact or interface deposits, 2 recurrence of the disease, 3 or subclinical allograft rejection. 4 Nevertheless, the presence of such changes has never led to retransplantation. 2 Moreover, the presence of guttae-like changes post DMEK has never been imaged with in vivo confocal microscopy (IVCM) to date.The aim of this study was to analyze guttae-like changes post DMEK and correlate clinical findings with SM and ICVM images in a case series of patients affected by FED.

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Section: Discussionmentioning

confidence: 99%

Section: Guttae-like Changes Post Descemet Membrane Endothelial Keratoplastymentioning

confidence: 99%

mentioning

confidence: 99%

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Guttae-like changes post Descemet membrane endothelial keratoplasty

Viola

Neri

Cian

et al. 2021

Canadian Journal of Ophthalmology

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“… 57 Baydoun et al studied the combined ability of specular microscopy with Scheimpflug imaging and reported that up to 90% of graft rejections could be predicted several months before the onset of rejection. 58 Our understanding of the above two imaging modalities also opens up a possibility that DMEK rejection may be a slow chronic process rather than an acute pathological one.…”

Section: Diagnosis Of Descemet Membrane Endothelial Keratoplasty Reje...mentioning

confidence: 99%

Risk Factors for Descemet Membrane Endothelial Keratoplasty Rejection: Current Perspectives- Systematic Review

Gurnani¹,

Kaur²,

Lalgudi³

et al. 2023

OPTH

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Descemet membrane endothelial keratoplasty (DMEK) is a corneal endothelial transplantation procedure with selective removal of a patient’s defective Descemet membrane and endothelium. It is replaced with a healthy donor Descemet membrane and endothelium without a stromal component. Corneal graft rejection can be at the level of epithelium, stroma as well endothelium. DMEK graft rejection is relatively less common than rejection with DSAEK or penetrating keratoplasty, and a good outcome may be achieved with prompt management. The clinical picture of DMEK rejection is usually similar to endothelial rejection in Descemet Stripping Endothelial Keratoplasty (DSEK/DSAEK), which generally manifests as pain, redness, reduction in visual acuity, stromal edema, endothelial rejection line, keratic precipitates at the back of the cornea and corneal neovascularization. However, more subtle forms of rejection or immune reactions are more common in DMEK compared to DSAEK eyes. Early clinical diagnosis, prompt intervention, and meticulous management safeguard visual acuity and graft survival in these cases. Intensive topical steroids form the mainstay in the management of DMEK rejection. Sometimes, oral or intravenous steroids or other systemic immunomodulators may be required. DMEK graft failure can be primary or secondary, and failure usually requires a second procedure in the form of repeat DMEK or DSEK or penetrating keratoplasty (PKP). A detailed literature search was performed using search engines such as Google Scholar, PubMed, and Google books, and a comprehensive review on DMEK rejection was found to be lacking. This review is a comprehensive update on the risk factors, pathophysiology, primary and secondary graft failure, recent advances in diagnosis, prevention of rejection, and updates in the management of DMEK rejection. The review also discusses the differential diagnosis of DMEK failure and rejection, prognosis, and future perspectives considering DMEK failure and rejection.

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“…Likewise, aqueous humor cytokine levels have been reported to increase during rejection of PK 8 . In addition, retrospective analysis of specular microscopy and Scheimpflug imaging has been shown to improve detection of allograft rejection following DMEK 9 . Using anterior segment OCT (AS-OCT), endothelial/Descemet membrane complex thickness (En/DMT) has been reported to accurately assess the immunological status of the corneal graft as compared to both endothelial cell density, and central corneal thickness 10 , 11 .…”

Section: Introductionmentioning

confidence: 99%

Prediction of corneal graft rejection using central endothelium/Descemet’s membrane complex thickness in high-risk corneal transplants

Eleiwa

Elsawy

Ozcan

et al. 2021

Sci Rep

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To determine whether measurements of Endothelium/Descemet complex thickness (En/DMT) are of predictive value for corneal graft rejection after high-risk corneal transplantation, we conducted this prospective, single-center, observational case series including sixty eyes (60 patients) at high risk for corneal graft rejection (GR) because of previous immunologic graft failure or having at least two quadrants of stromal vascularization. Patients underwent corneal transplant. At 1st, 3rd, 6th, 9th, and 12th postoperative month, HD-OCT imaging of the cornea was performed, and the corneal status was determined clinically at each visit by a masked cornea specialist. Custom-built segmentation tomography algorithm was used to measure the central En/DMT. Relationships between baseline factors and En/DMT were explored. Time dependent covariate Cox survival regression was used to assess the effect of post-operative En/DMT changes during follow up. A longitudinal repeated measures model was used to assess the relationship between En/DMT and graft status. Outcome measures included graft rejection, central Endothelium/Descemet’s complex thickness, and central corneal thickness (CCT). In patients with GR (35%), the central En/DMT increased significantly 5.3 months (95% CI: 2, 11) prior to the clinical diagnosis of GR, while it remained stable in patients without GR. During the 1-year follow up, the rejected grafts have higher mean pre-rejection En/DMTs (p = 0.01), compared to CCTs (p = 0.7). For En/DMT ≥ 18 µm cut-off (at any pre-rejection visit), the Cox proportional hazard ratio was 6.89 (95% CI: 2.03, 23.4; p = 0.002), and it increased to 9.91 (95% CI: 3.32, 29.6; p < 0.001) with a ≥ 19 µm cut-off. In high-risk corneal transplants, the increase in En/DMT allowed predicting rejection prior to the clinical diagnosis.

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Combined specular microscopy and Scheimpflug imaging to improve detection of an upcoming allograft rejection after DMEK

Cited by 6 publications

References 28 publications

Guttae-like changes post Descemet membrane endothelial keratoplasty

Guttae-like changes post Descemet membrane endothelial keratoplasty

Risk Factors for Descemet Membrane Endothelial Keratoplasty Rejection: Current Perspectives- Systematic Review

Prediction of corneal graft rejection using central endothelium/Descemet’s membrane complex thickness in high-risk corneal transplants

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