Monitoring cornea and graft morphometric dynamics after descemet stripping and endothelial keratoplasty with anterior segment optical coherence tomography.

PURPOSE: To evaluate the dynamics of cornea and graft thickness after Descemet stripping and endothelial keratoplasty (DSEK) using anterior segment optical coherence tomography (AS-OCT) and to assess the usefulness of AS-OCT in monitoring graft adherence after DSEK.

METHODS

Eighty-eight eyes from 86 patients underwent DSEK for Fuchs endothelial dystrophy or pseudophakic bullous keratopathy. Central corneal thickness (CCT), endothelial graft thickness (GT), interface fluid presence, graft dislocation, rate of CCT, and GT changes were measured with an AS-OCT during 12-month follow up.

RESULTS

The CCT averaged 788 microm preoperatively. On postoperative Day 1, mean CCT was 816 microm and GT was 191 microm. Compared with CCT on the first day, the changes in CCT on 2, 3, and 7 days were statistically nonsignificant. From 1 month to 12 months after DSEK, the CCT significantly diminished (P < 0.001). The CCT dynamics closely correlated with changes of GT and of the recipient's part of cornea. The most rapid rate of thickness decrease was observed between 1 week and 1 month: 5.34 microm/day for the entire cornea and 2.54 microm/day for endothelial disc. Between 1 month and 1 year, the CCT and GT were stable with only a trend toward further decrease. Entrapped fluid at graft/host interface on the first postoperative day was detectable by slit-lamp examination in 14 eyes (16%) and in 28 eyes (32%) in OCT.

CONCLUSION

The recovery of endothelial pump after DSEK takes place between 1 week and 1 month after DSEK. AS-OCT can be practically used for evaluation of the cornea dynamics as well as for the qualitative and quantitative assessment of graft-host interface after DSEK.