Korean J Transplant.  2023 Sep;37(3):203-209. 10.4285/kjt.23.0032.

Optical quality of the cornea after Descemet membrane endothelial keratoplasty surgery: early results from Türkiye

• Karaca EE
• Işık FD
• Kemer

• KMID: 2546499
• DOI: http://doi.org/10.4285/kjt.23.0032

Abstract

Background
Descemet membrane endothelial keratoplasty (DMEK) is increasingly favored in the treatment of endothelial dysfunction due to its benefits, which include swift visual rehabilitation and recovery, a relatively low rejection rate, and superior refractive stability. In this study, we examined alterations in corneal clarity among patients who underwent DMEK and correlated these densitometry findings with other optical parameters of corneal topography.
Methods
The study incorporated 35 eyes from 35 patients who had previously under-gone DMEK surgery for pseudophakic bullous keratopathy at Ankara Bilkent City Hospital. The results from these patients were compared with those from a healthy control group. The preoperative and postoperative optical parameters of the patients were as- sessed using Pentacam Scheimpflug topography (Oculus).
Results
We observed significant decreases in corneal densitometry in the 0–2 mm and 2–6 mm zones of the anterior, posterior, central, and total layers at the sixth month postoperatively compared to the preoperative period (P<0.05). The corneal densitome- try values at postoperative month 6 were elevated in all layers and zones relative to the healthy group (P<0.05). The root mean square of higher-order aberrations in postoperative period was elevated significantly (P<0.001).
Conclusions
Six months after operation, the optical quality of the cornea following DMEK surgery did not achieve the level of a healthy cornea.

Keyword

Cornea; Cornea transplantation; Lamellar keratoplasty

Figure

• 

  Fig. 1 Corneal densitometry.

• 

  Fig. 2 (A) Corneal densitometry with (B) increased corneal clarity.

• 

  Fig. 3 (A) Corneal densitometry with (B) decreased corneal clarity.

Reference

1. DelMonte DW, Kim T. 2011; Anatomy and physiology of the cornea. J Cataract Refract Surg. 37:588–98. DOI: 10.1016/j.jcrs.2010.12.037. PMID: 21333881.

2. Schaub F, Enders P, Bluhm C, Bachmann BO, Cursiefen C, Heindl LM. 2017; Two-year course of corneal densitometry after Descemet membrane endothelial keratoplasty. Am J Ophthalmol. 175:60–7. DOI: 10.1016/j.ajo.2016.11.019. PMID: 27986425.

3. Melles GR, Ong TS, Ververs B, van der Wees J. 2008; Preliminary clinical results of Descemet membrane endothelial keratoplasty. Am J Ophthalmol. 145:222–7. DOI: 10.1016/j.ajo.2007.09.021. PMID: 18061137.

4. Laaser K, Bachmann BO, Horn FK, Cursiefen C, Kruse FE. 2012; Descemet membrane endothelial keratoplasty combined with phacoemulsification and intraocular lens implantation: advanced triple procedure. Am J Ophthalmol. 154:47–55. DOI: 10.1016/j.ajo.2012.01.020. PMID: 22465365.

5. Patel SV, McLaren JW, Hodge DO, Bourne WM. 2008; The effect of corneal light scatter on vision after penetrating keratoplasty. Am J Ophthalmol. 146:913–9. DOI: 10.1016/j.ajo.2008.07.018. PMID: 18774549. PMCID: PMC2612528.

6. Ní Dhubhghaill S, Rozema JJ, Jongenelen S, Ruiz Hidalgo I, Zakaria N, Tassignon MJ. 2014; Normative values for corneal densitometry analysis by Scheimpflug optical assessment. Invest Ophthalmol Vis Sci. 55:162–8. DOI: 10.1167/iovs.13-13236. PMID: 24327608.

7. Koh S, Maeda N, Nakagawa T, Nishida K. 2012; Quality of vision in eyes after selective lamellar keratoplasty. Cornea. 31 Suppl 1:S45–9. DOI: 10.1097/ICO.0b013e318269c9cd. PMID: 23038035.

8. Gellert A, Unterlauft JD, Rehak M, Girbardt C. 2022; Descemet membrane endothelial keratoplasty (DMEK) improves vision-related quality of life. Graefes Arch Clin Exp Ophthalmol. 260:3639–45. DOI: 10.1007/s00417-022-05711-9. PMID: 35612615. PMCID: PMC9581807.

9. Gurnani B, Kaur K, Lalgudi VG, Tripathy K. 2023; Risk factors for Descemet membrane endothelial keratoplasty rejection: current perspectives-systematic review. Clin Ophthalmol. 17:421–40. DOI: 10.2147/OPTH.S398418. PMID: 36755886. PMCID: PMC9899935.

10. Alio JL, Shabayek MH. 2006; Corneal higher order aberrations: a method to grade keratoconus. J Refract Surg. 22:539–45. DOI: 10.3928/1081-597X-20060601-05. PMID: 16805116.

11. Melles GR, Ong TS, Ververs B, van der Wees J. 2006; Descemet membrane endothelial keratoplasty (DMEK). Cornea. 25:987–90.

12. Yoeruek E, Bayyoud T, Hofmann J, Bartz-Schmidt KU. 2013; Novel maneuver facilitating Descemet membrane unfolding in the anterior chamber. Cornea. 32:370–3. DOI: 10.1097/ICO.0b013e318254fa06. PMID: 22820605.

13. Liarakos VS, Dapena I, Ham L, van Dijk K, Melles GR. 2013; Intraocular graft unfolding techniques in Descemet membrane endothelial keratoplasty. JAMA Ophthalmol. 131:29–35. DOI: 10.1001/2013.jamaophthalmol.4. PMID: 22965272.

14. Peraza-Nieves J, Baydoun L, Dapena I, Ilyas A, Frank LE, Luceri S, et al. 2017; Two-year clinical outcome of 500 consecutive cases undergoing Descemet membrane endothelial keratoplasty. Cornea. 36:655–60. DOI: 10.1097/ICO.0000000000001176. PMID: 28410548.

15. Monnereau C, Quilendrino R, Dapena I, Liarakos VS, Alfonso JF, Arnalich-Montiel F, et al. 2014; Multicenter study of Descemet membrane endothelial keratoplasty: first case series of 18 surgeons. JAMA Ophthalmol. 132:1192–8. DOI: 10.1001/jamaophthalmol.2014.1710. PMID: 24993643.

16. Turnbull AM, Tsatsos M, Hossain PN, Anderson DF. 2016; Determinants of visual quality after endothelial keratoplasty. Surv Ophthalmol. 61:257–71. DOI: 10.1016/j.survophthal.2015.12.006. PMID: 26708363.

17. van Dijk K, Droutsas K, Hou J, Sangsari S, Liarakos VS, Melles GR. 2014; Optical quality of the cornea after Descemet membrane endothelial keratoplasty. Am J Ophthalmol. 158:71–9. DOI: 10.1016/j.ajo.2014.04.008. PMID: 24784873.

18. Cabrerizo J, Livny E, Musa FU, Leeuwenburgh P, van Dijk K, Melles GR. 2014; Changes in color vision and contrast sensitivity after Descemet membrane endothelial keratoplasty for Fuchs endothelial dystrophy. Cornea. 33:1010–5. DOI: 10.1097/ICO.0000000000000216. PMID: 25119964.

19. Schoenberg ED, Price FW Jr, Miller J, McKee Y, Price MO. 2015; Refractive outcomes of Descemet membrane endothelial keratoplasty triple procedures (combined with cataract surgery). J Cataract Refract Surg. 41:1182–9. DOI: 10.1016/j.jcrs.2014.09.042. PMID: 26096520.

20. Machalinska A, Kuligowska A, Kaleta K, Kusmierz-Wojtasik M, Safranow K. 2021; Changes in corneal parameters after DMEK surgery: a swept-source imaging analysis at 12-month follow-up time. J Ophthalmol. 2021:3055722. DOI: 10.1155/2021/3055722. PMID: 34336256. PMCID: PMC8321767.

21. Satue M, Idoipe M, Gavin A, Romero-Sanz M, Liarakos VS, Mateo A, et al. 2018; Early changes in visual quality and corneal structure after DMEK: does DMEK approach optical quality of a healthy cornea? J Ophthalmol. 2018:2012560. DOI: 10.1155/2018/2012560. PMID: 30345110. PMCID: PMC6174748.

22. Rudolph M, Laaser K, Bachmann BO, Cursiefen C, Epstein D, Kruse FE. 2012; Corneal higher-order aberrations after Descemet's membrane endothelial keratoplasty. Ophthalmology. 119:528–35. DOI: 10.1016/j.ophtha.2011.08.034. PMID: 22197439.

23. Alnawaiseh M, Zumhagen L, Wirths G, Eveslage M, Eter N, Rosentreter A. 2016; corneal densitometry, central corneal thickness, and corneal central-to-peripheral thickness ratio in patients with Fuchs endothelial dystrophy. Cornea. 35:358–62. DOI: 10.1097/ICO.0000000000000711. PMID: 26655484.

24. Baratz KH, McLaren JW, Maguire LJ, Patel SV. 2012; Corneal haze determined by confocal microscopy 2 years after Descemet stripping with endothelial keratoplasty for Fuchs corneal dystrophy. Arch Ophthalmol. 130:868–74. DOI: 10.1001/archophthalmol.2012.73. PMID: 22410629.

25. Schaub F, Gerber F, Adler W, Enders P, Schrittenlocher S, Heindl LM, et al. 2019; Corneal densitometry as a predictive diagnostic tool for visual acuity results after Descemet membrane endothelial keratoplasty. Am J Ophthalmol. 198:124–9. DOI: 10.1016/j.ajo.2018.10.002. PMID: 30315754.