Guttae-like changes post Descemet membrane endothelial keratoplasty

Abstract

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.

Corneal Guttae After Descemet Membrane Endothelial Keratoplasty

“…keratoplasty (PK), corneal guttae were observed in 13% to 26% of the grafts, 6,10,15 for Descemet stripping automated endothelial keratoplasty (DSAEK) in 3% of the grafts (from the same study that reported a rate of 13% after PK), 6 and for DMEK in 4% to19% of the eyes. 11,14 Occurrence of corneal guttae in this case series could be detected within the first postoperative month which corroborates previous reports on the early guttae occurrence after DSAEK and DMEK. 9,11 Along with the fact that corneal guttae have been observed for patients with surgery indications other than FECD, [6][7][8][9][10]12,15 this supports the hypothesis that the corneal guttae originate from the donor tissue.…”

“…11,14 Occurrence of corneal guttae in this case series could be detected within the first postoperative month which corroborates previous reports on the early guttae occurrence after DSAEK and DMEK. 9,11 Along with the fact that corneal guttae have been observed for patients with surgery indications other than FECD, [6][7][8][9][10]12,15 this supports the hypothesis that the corneal guttae originate from the donor tissue. Differences in the reported postoperative incidence of corneal guttae could then either be due to differences in the screening protocol between eye banks providing the corneal grafts or be due to differences in the postoperative detection of corneal guttae.…”

“…This may result in donor tissue containing guttae being released for transplantation and guttae becoming visible postoperatively. [6][7][8][9][10][11][12][13][14][15] Reported incidences of postoperative corneal guttae varies in the literature for penetrating and endothelial keratoplasty. For penetrating A-E, Central specular microscopy images of case #4 who underwent primary DMEK for pseudophakic bullous keratopathy.…”

“…This may result in donor tissue containing guttae being released for transplantation and guttae becoming visible postoperatively. 6–15 Reported incidences of postoperative corneal guttae varies in the literature for penetrating and endothelial keratoplasty. For penetrating keratoplasty (PK), corneal guttae were observed in 13% to 26% of the grafts, 6,10,15 for Descemet stripping automated endothelial keratoplasty (DSAEK) in 3% of the grafts (from the same study that reported a rate of 13% after PK), 6 and for DMEK in 4% to19% of the eyes.…”

“…6 The detection of guttae, however, can be challenging, and the occurrence of guttae after corneal transplantation has been reported. [6][7][8][9][10][11][12][13][14][15] Isolated corneal guttae or patches of confluent corneal guttae have been identified in up to 25% of corneal grafts after penetrating keratoplasty 6 and in up to 18.7% of corneal grafts after Descemet membrane endothelial keratoplasty (DMEK). 14 Because DMEK is nowadays a preferred treatment option for endothelial diseases, in the current study, we report in more detail on the different appearances of corneal guttae after DMEK and on the longer-term effect of the guttae on clinical outcomes.…”