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AS-OCT facilitates decision making regarding surgical re-intervention after DMEK
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WARSAW, Poland — Anterior segment optical coherence tomography showed high predictive value in evaluating graft adherence status and may facilitate decision making regarding surgical re-intervention after Descemet’s membrane endothelial keratoplasty.
“Graft detachment is the most frequent complication in endothelial keratoplasty, occurring in about 10% of our cases at the NIIOS clinic in Rotterdam,” Marina Rodríguez Calvo de Mora, MD, said at the winter meeting of the European Society of Cataract and Refractive Surgeons.
However, rebubbling may not be necessary in all cases, she said.
Marina Rodríguez Calvo de Mora
In a study, 87 eyes of 87 patients were scanned with AS-OCT within the first hour after DMEK and then at 1 week, 1 month, and 3 and 6 months. For each time interval, detachments were classified as none, one-third detachment or less, or more than one-third detachment of the total graft.
Based on AS-OCT findings, a nomogram for intervention was developed.
“If in 1 week grafts are attached or detached by less than one-third, we should ignore them, because they remain stable or progressively improve, leading to good visual acuity in all cases at 6 months. If detachment is more than one-third, we should check the 1 hour AS-OCT. If at 1 hour the graft is attached, we don’t have to worry because in 96% of the cases the graft will reattach within 6 months. But detached grafts at 1 week and 1 hour will remain detached in 75% of the cases and reattach in 25% of the cases,” Rodríguez Calvo de Mora said.
Rebubbling may be needed in some cases, but observation for at least 1 month is necessary because spontaneous reattachment cannot be excluded, she said.
Disclosure: Rodríguez Calvo de Mora has no relevant financial disclosures.