Descemet stripping automated endothelial keratoplasty (DSAEK) with thin grafts in patients suffered bullous keratophaty with low preoperative visual acuity

Purpose: To evaluate the results of DSAEK with thin grafts in patients suffered bullous keratophaty with low preoperative visual acuity.

Methods: DSAEK with thin grafts the thickness of which was 150‑70 μm was fulfilled in 47 patients (47 eyes) suffered bullous keratophaty without visible leukomas in the corneal stroma. Visual acuity prior to the operation with a maximum spectacle correction accounted for an average of 0.05±0.04. Tear film osmolarity of 20 patients (20 eyes) who participated in the research was measured. 

Results: In follow-up period graft kept transparency in 39 patients. Visual acuity in 3 months after the operation, on average, without correction was 0.38±0.16, with a maximum of spectacle correction is 0.51± 0.18. The spherical component varied in the range from 0 to 3.75 D, with an average of 1.63 per±1.1 D. Corneal astigmatism was from 0.5 to 4.0 D, an average of 1.8±0.98 D. At preoperative osmolarity indicators were within the normal reference for both operated and non-operated eyes — 292.3±10.4 и 279.3±3.51. In a first postoperative week osmolarity was not detected while on a non-operated eye it was 278.4±1.4. After 1, 3 and 6 months osmolarity indicators on both eyes were within normal reference. Spherical component ranged from 0 to 3.75 D, averaging 1.1±1.63 D. Corneal astigmatism ranged from 0.5 to 4.0 (D), with an average of 1.8±0.98 D 1.63 per±1.1 D.

Conclusion: DSAEK with thin grafts is an effective modern methods of surgical treatment of bullous keratophaty. For old patients with severe ocular pathology — concomitant eye diseases, repeated surgery of the eye, the developed stage of the keratophaty — we have not noted the apparent correlation between the thickness of the transplant, visual acuity and the time of recovery of visual functions after keratoplasty. Osmolarity in an early postoperative period is a non-informative method of diagnostics. Restoration of osmolarity level to preoperative level is expected within one month after the surgery.

1. Бржеский В. В. Современные возможности замещения муцинового слоя прероговичной слезной пленки // Офтальмология. — 2011. — Т. 8, № 1. — С. 53‑57.

2. Майчук Ю. Ф., Селиверстова К. Е, Бржеский В. В и др. Современные методы диагностики воспалительных заболеваний конъюнктивы и синдрома «сухого глаза» // Поле зрения. 2010. № 2. С.6.

3. Малюгин Б. Э., Мороз З. И., Ковшун Е. В. и др. Задняя автоматизированная послойная кератопластика с использованием ультратонких трансплантатов //Материалы IX съезда офтальмологов России. М., 2010. С. 310‑311.

4. Мамиконян В. Р., Труфанов С. В., Бородина Н. В. Результаты применения современных модификаций автоматизированной эндотелиальной кератопластики // Вестн. офтальмол. 2012. № 4. С. 3‑11.

5. Оганесян О. Г. Система хирургической реабилитации пациентов с эндотелиальной патологией роговицы: Автореф. дис. … д-ра мед. наук. М., 2011.

6. Полунин Г. С., Сафонова Т. Н., Полунина Е. Г. Особенности клинического течения различных форм синдрома сухого глаза — основа для разработки адекватных методов лечения // Вестн. офтальмол. — 2006. — Т. 102, № 5. — С.17‑20.

7. Busin M, Beltz J, Patel A, Scorcia V. Ultrathin DSAEK: Future of endothelial keratoplasty? ASCRS, 2011. Annual Symposium, Course 28‑306, March 28, 2011, San Diego, CA.

8. Dawson DG, Edelhauser HF, Grossniklaus HE. Long-term histopathologic findings in human corneal wounds after refractive surgical procedures // Am J Ophthalmol. 2005. V. 139. P. 168‑178.

9. Guerra FP, Anshu A, Price MO, et al. Descemet’s membrane endothelial keratoplasty: prospective study of 1‑year visual outcomes, graft survival, and endothelial cell loss // Ophthalmology. 2011. V. 118. P. 2368‑2373.

10. Hu MY, McCulley JP, Cavanagh HD, et al. Comparison of the corneal response to laser in situ keratomileusis with flap creation using the FS15 and FS30 femtosecond lasers: clinical and confocal microscopy findings // J Cataract Refract

11. Surg. 2007. V. 33. P. 673‑681.

12. Ivarsen A, Thøgersen J, Keiding SR, et al. Plastic particles at the LASIK interface // Ophthalmology. 2004. V. 111. P. 18‑23.

13. Li JY, Terry MA, Goshe J, et al. Three-year visual acuity outcomes after Descemet’s stripping automated endothelial keratoplasty // Ophthalmology. 2012. V. 119. P. 1126‑1129.

14. McCauley MB, Price MO, Fairchild KM, et al. Prospective study of visual outcomes and endothelial survival with Descemet membrane automated endothelial keratoplasty // Cornea. 2011. V. 30. P. 315‑319.

15. Neff KD, Biber JM, Holland EJ. Comparison of central corneal graft thickness to visual acuity outcomes in endothelial keratoplasty // Cornea. 2011. V. 30. P. 388‑391.

16. Perez-Gomez I, Cameron I, Efron N. Particles at the laser in situ keratomileusis flap interface // J Cataract Refract Surg. 2004. V. 30. P. 2021.

17. Price MO, Giebel AW, Fairchild KM, et al. Descemet’s membrane endothelial keratoplasty: prospective multicenter study of visual and refractive outcomes and endothelial survival // Ophthalmology. 2009. V. 116. P. 2361‑2368.

18. Price MO, Price FW Jr. Endothelial keratoplasty a review. Clin Experiment Ophthalmol // 2010. V. 38. P. 128‑140.