J Korean Ophthalmol Soc.  2015 May;56(5):664-671. 10.3341/jkos.2015.56.5.664.

Clinical Outcomes of Nd-YAG Laser Membranotomy in Retained Host Corneal Membrane after Keratoplasty

• Kim YC
• Hwang JH
• Kim MS

• KMID: 2121162
• DOI: http://doi.org/10.3341/jkos.2015.56.5.664

Abstract

PURPOSE
To evaluate the clinical efficacy and shortcomings of neodymium-doped yttrium aluminum garnet (Nd-YAG) laser membranotomy in inadvertently retained host membrane.
METHODS
Among 742 patients who underwent penetrating keratoplasty (PKP) and deep anterior lamellar keratoplasty (DALK) surgery at Seoul St. Mary's Hospital between January 2007 and May 2013 by a single surgeon, 10 patients had a thin, opaque membrane in the anterior chamber observed under slit lamp examination and both a subjective decrease in visual acuity and decrease i best corrected visual acuity. A single surgeon performed membranotomy using the Nd-YAG laser at 4.9 months after graft surgery. In this study we compared the differences in visual acuity, endothelial cell count and correlations between distance from donor endothelium and retained host membrane and endothelial loss before and after the graft surgery.
RESULTS
Patients who had Nd-YAG laser membranotomy performed on the retained host membrane showed significant improvements in visual acuity (p = 0.039). Donor endothelial cell count was significantly reduced 1 month after Nd-YAG laser. The average distance between donor endothelium and retained host membrane was 712.0 +/- 217.5 microm. The distance and the decreased donor endothelial cell count were not statistically correlated (R2 = 0.39, p = 0.072). There were no significant complications after the laser membranotomy.
CONCLUSIONS
Inadvertently retained host membrane forms close to the donor endothelium as identified on optical coherence tomography (OCT) images. Nd-YAG laser membranotomy significantly affected clear vision but endothelial cell count loss was also observed.

Keyword

DALK surgery; Endothelial cell count; Nd-YAG laser; PKP surgery; Retained host membrane

MeSH Terms

Aluminum
Anterior Chamber
Corneal Transplantation*
Endothelial Cells
Endothelium
Humans
Keratoplasty, Penetrating
Lasers, Solid-State*
Membranes*
Seoul
Tissue Donors
Tomography, Optical Coherence
Transplants
Visual Acuity
Yttrium
Aluminum
Yttrium

Figure

• 

  Figure 1. Retained host membrane after keratoplasty (slit lamp photo). (A) Retained host membrane in front of the pupil is seen in slit lamp photo taken at the day after surgery. The opacity of the membrane is marked, even by naked eyes. Clear space is seen between the membrane and recipient’s peripheral cornea. (B) Retained host membrane is perforated in rec-tangular shape, 5 months after the surgery. Visual axis is well spared with 2.0 mm wide, 2.5 mm long perforation area. The cornea is transparent.

• 

  Figure 2. Cross sectional image at the level of grafted cornea and retained host membrane. (A, B) Distance between graft endothelium and retained host membrane is measured with spectralis-domain HRA anterior OCT imaging taken at the day after surgery. Distance is variable but relatively close to the graft cornea endothelium. Retained host membrane itself is very thin. (C) Spectralis OCT taken 5 months after the surgery. Retained host membrane is perforated, graft corneal endothelium is intact. The membrane is noticeably thicker. HRA = Heidelberg retina angiograph; OCT = optical coherence tomography.

Reference

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