Predictive value of optical coherence tomography in graft attachment after Descemet membrane endothelial keratoplasty

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Abstract

Purpose

To evaluate the predictive value of early anterior segment optical coherence tomography (AS-OCT) on graft adherence or detachment after Descemet membrane endothelial keratoplasty (DMEK).

Methods

Retrospective study of prospectively collected data at a tertiary referral center. 87 eyes of 87 patients out of a consecutive series of 142 DMEK surgeries were included in the study AS-OCT was performed within the first hour after DMEK, and at 1- week, 1-month, 3-months and 6-months, and for each time interval detachments were classified as ‘none’, ≤1/3 detachment, >1/3 detachment of the total graft surface area, or ‘complete’ detachment. Throughout the study no re-bubbling procedures were performed. The main outcome measure was graft adherence at various postoperative time intervals.

Results

1-hour AS-OCT scans were more accurate at predicting the final 6-month graft adherence status than those at 1-week or 1-month. Grafts showing complete attachment or <1/3 detachment at 1-hour, remained stable or improved in 73% of the cases at 1-week, 82% at 1-month, 86% at 3-months, and 90% at 6-months, respectively. All grafts attached at 1-week, remained attached at 6-months. Graft detachments of >1/3 at 1-hour showed re-attachment at 6 months in 25% of the cases, while 67.5% of the cases showed a persistent detachment of >1/3 at 6 months and 12.5% a complete detachment.

Conclusion

The 1-hour AS-OCT showed best predictive value on 6-month graft adherence status. The combined information of the 1-hour and 1-week AS-OCT may facilitate decision making on surgical re-intervention after DMEK.

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