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

Ophthalmology. 2013 Feb;120(2):240-5. doi: 10.1016/j.ophtha.2012.08.011. Epub 2012 Nov 11.


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

Design: Retrospective study of prospectively collected data at a tertiary referral center.

Participants: A total of 87 eyes of 87 patients of a consecutive series of 142 DMEK surgeries.

Methods: Anterior segment 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 rebubbling procedures were performed.

Main outcome measures: Graft adherence at various postoperative time intervals.

Results: One-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. All grafts attached at 1 week remained attached at 6 months. Graft detachments of >1/3 at 1 hour showed reattachment at 6 months in 25% of the cases, whereas 67.5% of the cases showed a persistent detachment of >1/3 at 6 months and 12.5% showed a complete detachment.

Conclusions: The 1-hour AS-OCT scan showed the best predictive value on 6-month graft adherence status. The combined information of the 1-hour and 1-week AS-OCT scans may facilitate decision making about surgical reintervention after DMEK.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Descemet Stripping Endothelial Keratoplasty*
  • Endothelium, Corneal / anatomy & histology*
  • Female
  • Fuchs' Endothelial Dystrophy / surgery
  • Graft Survival / physiology*
  • Humans
  • Male
  • Predictive Value of Tests
  • Prospective Studies
  • Refraction, Ocular / physiology
  • Retrospective Studies
  • Time Factors
  • Tissue Adhesions
  • Tomography, Optical Coherence*
  • Visual Acuity / physiology