Original articleIn Vivo Laser Confocal Microscopy after Non–Descemet's Stripping Automated Endothelial Keratoplasty
Section snippets
Patients and Methods
The study was approved by the Ethical Committee of Kanazawa University Graduate School of Medical Science and followed the tenets of the Declaration of Helsinki. Table 1 summarizes the demographic data of the 10 patients (3 men, 7 women; mean age, 73.5±6.6 years [mean±standard deviation (SD)]) with bullous keratopathy who enrolled in this study; simultaneous cataract surgery was performed for 6 cases. Nine patients had undergone previous argon laser iridotomy for angle-closure glaucoma attack (
Clinical Outcomes
All 10 patients (100%) reached better than 20/32 best-corrected visual acuity within 6 months after nDSAEK (Fig 2A). Four patients (40.0%) reached better-than 20/20 visual acuity, and 1 patient (10.0%) reached 20/16 visual acuity within 6 months. Within 1 year, 7 patients (70.0%) reached more than 20/20 visual acuity, and 2 patients (20.0%) reached 20/16 visual acuity. Mean induced astigmatism±SD in measurable cases at 6 months after surgery was 0.67±0.45 diopters (D; range, 0.25–1.5 D).
Discussion
Herein are reported prospective, qualitative, and quantitative evaluations with in vivo laser confocal microscopy of 10 corneas with bullous keratopathies treated with nDSAEK. As a result, characteristic in vivo cellular and corneal stromal changes were identified that occur in the first 6 months of postoperative follow-up. These findings may contribute new knowledge about the wound-healing process that takes place at the interface between recipient cornea with nonstripped Descemet's membrane
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2013, OphthalmologyCitation Excerpt :These stromal micropathologic features were observed characteristically in acute phases of noninfectious keratits,22 and they also can be detected in advanced amoebic keratitis with more extensive stromal involvement. Previously, it was reported that tiny needle-like materials were observed in several diseases including corneal dystrophies,23 bullous keratopathies,24,25 and chronic cytomegalovirus corneal endotheliitis.26 Although the precise origin and significance of these needle-like materials remain unclear, it is surmised that the cause of needle-like materials may be crystalline or lipofuscin deposits, and these may reflect chronic abnormalities of the corneal stroma.
In vivo laser confocal microscopy after descemet's membrane endothelial keratoplasty
2013, OphthalmologyCitation Excerpt :In contrast, the mean scores after DSAEK and nDSAEK decreased from 2.0 and 2.8 preoperatively to 1.29 and 1.4 at 6 months postoperatively, respectively. As noted previously,29,30 we surmise that preoperative and postoperative subepithelial haze detectable by confocal microscopy may be a pathologic anterior stromal change that is due to bullous keratopathy. Although the precise reason why the subepithelial haze after DMEK did not dramatically decrease is unclear, we attribute it to the causative diseases; most cases of DSAEK/nDSAEK were bullous keratopathies after argon laser iridotomy in which preoperative stromal bullous change was severe.
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2012, American Journal of OphthalmologyCitation Excerpt :In vivo laser confocal microscopy demonstrated epithelial edema in 2 patients (2/6; 33.3%), reduced or nondetectable subepithelial nerves in all patients (100%; 6/6), reduced stromal nerves in 2 patients (2/6; 33.3%), subepithelial opacity in all patients (6/6; 100%), increased reflectivity of keratocytes in all patients (6/6; 100%), and highly reflective dots and needle-shaped bodies in all patients (6/6; 100%). These confocal characteristics most likely were the result of common pathologic changes seen in edematous cornea caused by endothelial dysfunction, corneal stromal inflammation, or both.16,20–23 However, the precise origin and significance of these pathologic changes remain unclear.
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Manuscript no. 2008-1151.
Financial Disclosure(s): The author(s) have no proprietary or commercial interest in any materials discussed in this article.