In Vivo Laser Confocal Microscopy after Non–Descemet's Stripping Automated Endothelial Keratoplasty
Received 23 September 2008; received in revised form 25 December 2008; accepted 30 January 2009.
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.
Department of Ophthalmology, Kanazawa University Graduate School of Medical Science, Kanazawa, Japan
Correspondence: Akira Kobayashi, MD, PhD, Department of Ophthalmology, Kanazawa University Graduate School of Medical Science, 13-1 Takara-machi, Kanazawa-shi, Ishikawa-ken 920-8641, Japan
Manuscript no. 2008-1151.
Financial Disclosure(s): The author(s) have no proprietary or commercial interest in any materials discussed in this article.
ABSTRACT