J Korean Ophthalmol Soc.  2011 Jun;52(6):679-689. 10.3341/jkos.2011.52.6.679.

Long-term Clinical Outcomes of Femtosecond LASER-Assisted Descemet's Stripping Endothelial Keratoplasty

• Moon BG
• Kim JH
• Lee JE
• Kim MJ
• Kim JY
• Tchah H

• KMID: 2214639
• DOI: http://doi.org/10.3341/jkos.2011.52.6.679

Abstract

PURPOSE
To evaluate the long-term clinical outcomes of femtosecond LASER-assisted Descemet's stripping endothelial keratoplasty (DSEK).
METHODS
The clinical results of endothelial keratopathy from 11 consecutive patients who were followed up for at least 12 months after femtosecond LASER-assisted DSEK were retrospectively analyzed. The best corrected visual acuities (BCVA), manifest refractions, intraocular pressures, and perioperative complications were evaluated preoperatively and up to 24 months after the femtosecond LASER-assisted DSEK.
RESULTS
The average follow-up period was 18 months. Postoperative visual acuity had significantly improved from 1.26 (logMAR) to 0.80 (logMAR) at 3 months (p < 0.05) and this change was maintained during postoperative follow-up. All eyes underwent successful transplantation and the donor discs were well-attached. The mean endothelial cell density continued to decrease during the follow-up period. The donor-recipient stromal interface was the area where varying degree of haziness and birefringent particles were found.
CONCLUSIONS
The femtosecond LASER-assisted DSEK was effective in creating an endothelial donor disc which resulted in rapid visual recovery and low surgically-induced astigmatism. However, the operation caused rapid decrease in endothelial cell density which requires continuing further consideration by the physician.

Keyword

Anterior segment optical coherent tomography; Confocal microscopy; Femtosecond LASER-assisted Descetmet's stripping endothelial keratoplasty

MeSH Terms

Astigmatism
Corneal Transplantation
Endothelial Cells
Eye
Follow-Up Studies
Humans
Intraocular Pressure
Microscopy, Confocal
Retrospective Studies
Tissue Donors
Transplants
Visual Acuity

Figure

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  Figure 1. The mean pre-operative and postoperative best corrected visual acuity (BCVA) expressed as the logarithm of the minimum angle of resolution (logMAR) (A). The mean values of pre-operative and postoperative intraocular pressure measured by Tonopen (B). (* p<0.05).

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  Figure 2. The recipient's corneal thickness and the donor disc at the vertex.

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  Figure 3. Slit lamp photograph after air injection into the anterior chamber of patient 6 showing corneal edema and previous stromal puncture sites (A). The high resolution anterior segment optical coherence tomography showed that interface space still remained in this patient (B). Slit lamp photograph of patient 7 showing the white interface opacity between the recipient's cornea and the donor disc (C). The anterior segment OCT of the same patient showed the thickness at the vertex and at 2.0 mm and 3.5 mm on each side of the vertex (D). The high resolution anterior segment optical coherence tomography of patient 5 showed thickened posterior corneal disc center which was suspected to be caused by the donor disc being cut unevenly at the time of operation (E).

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  Figure 4. The post-operative endothelial cell density (cells/ mm2). * p < 0.05 in ANOVA.

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  Figure 5. The grading of donor-recipient stromal interface haziness: Grade 1 (very mild haze) (A), Grade 2 (mild haze) (B), Grade 3 (moderate haze) (C), and Grade 4 (severe haze) (D).

Reference

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