In Vivo Laser Confocal Microscopy After Descemet Stripping with Automated Endothelial Keratoplasty

Intraocular pressure after Descemet’s stripping and non-Descemet’s stripping automated endothelial keratoplasty

“…DSAEK and nDSAEK procedures are described in detail by Kobayashi and Yokogawa and colleagues. 7,8,10 In brief, donor grafts for all 24 eyes were prepared with a microkeratome (ALTK Cbm, Moria, Antony, France) equipped with a 300-μm head and an 8.0-mm-diameter punch (Barron donor cornea punch, Katena Products, Denville, NJ, USA). In 14 of the 24 cases, simultaneous cataract procedures (phacoemulsifi cation and intraocular lens implantation) were performed just prior to both the DSAEK and nDSAEK surgery.…”

“…4,6 Recently, we reported a successful modifi cation of DSAEK without Descemet's membrane peeling for bullous keratopathies secondary to Argon laser iridotomy; we termed the modifi ed procedure non-Descemet's stripping automated endothelial keratoplasty (nDSAEK). 7,8 After both DSAEK and nDSAEK surgery, corneal thickness inevitably increases owing to the addition of the donor graft. Therefore, there is a possibility that intraocular pressure (IOP) measurement methods dependent on normal corneal thickness, such as Goldmann applanation tonometry (GAT), may produce less accurate readings.…”

Determinants of visual quality after endothelial keratoplasty

“…72,77,108,138 . Possible explanations for this include optical degradation at the graftrecipient interface, 64 increased corneal thickness, increased high order aberrations, stromal scarring and fibrosis secondary to the underlying pathology, and increased light scatter. 54 In their review, Anshu et al commented that a higher proportion of patients receiving PKP for endothelial dysfunction may eventually achieve BCVA of 20/20 through the use of hard contact lenses; 5 however, no primary data was provided in support of this claim.…”

“…15,77,94 A confocal microscopy study of DSAEK found that haze reduced between one and six months after surgery, and that subepithelial and interface haze persisting at six months was a risk factor for decreased visual performance. 64 Accordingly, good preoperative vision secondary to milder anterior corneal changes is a predictor of better visual outcomes postoperatively. 94,121 6.…”

“…101 Similarly, "needle-shaped" particles have been found within the deep host stroma, but again their source and importance is uncertain. 64 An optical coherence tomography (OCT) study of 14 eyes with interface haze post-DSAEK found that,although haze tended to improve, it caused persistently reduced vision in 3 eyes, necessitating re-grafting. 63 In these re-grafted eyes, histopathology revealed no inflammation, foreign body deposits or fibrosis, and the authors proposed that retained ophthalmic viscosurgical device (OVD), or another adhesive property of the OVD, was the cause for interface haze 63 -a suggestion supported by an earlier study.…”