Elsevier

Ophthalmology

Volume 116, Issue 7, July 2009, Pages 1306-1313
Ophthalmology

Original article
In Vivo Laser Confocal Microscopy after Non–Descemet's Stripping Automated Endothelial Keratoplasty

https://doi.org/10.1016/j.ophtha.2009.01.053Get rights and content

Objective

To investigate in vivo corneal changes in patients with bullous keratopathy who underwent non–Descemet's stripping automated endothelial keratoplasty (nDSAEK) with the use of laser confocal microscopy.

Design

Single-center, prospective clinical study.

Participants

Ten eyes (10 patients; 3 men and 7 women; mean age, 73.5±6.6 years [mean±standard deviation]) with bullous keratopathy were evaluated in this study.

Testing

In vivo laser confocal microscopy was performed before and 1, 3, and 6 months after nDSAEK.

Main Outcome Measures

Selected confocal images of corneal layers were evaluated qualitatively and quantitatively for degree of haze and density of deposits.

Results

Before surgery, the following were observed in all patients: corneal epithelial edema, subepithelial haze, keratocytes in a honeycomb pattern, and tiny needle-shaped materials in the stroma. After nDSAEK, subepithelial haze, donor–recipient interface haze, and interface particles were observed in all measurable cases; postoperative haze, interface particles, and needle-shaped materials decreased statistically significantly (P<0.05) over the course of follow-up. In addition, hyperreflective giant interface particles were observed after nDSAEK in all patients.

Conclusions

In vivo laser confocal microscopy can identify subclinical corneal abnormalities after nDSAEK such as subepithelial haze, host–recipient interface haze, host stromal needle-shaped materials, and host–recipient interface particles with characteristic giant particles. Further studies with this technology in a large number of patients and long-term follow-up are needed to understand fully the long-term corneal stromal changes after nDSAEK.

Financial Disclosure(s)

The author(s) have no proprietary or commercial interest in any materials discussed in this article.

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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    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, Ophthalmology
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    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.

  • Clinical significance of owl eye morphologic features by in vivo laser confocal microscopy in patients with cytomegalovirus corneal endotheliitis

    2012, American Journal of Ophthalmology
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    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.

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