Posterior Stromal Ripples Increase The Risk Of Descemet Membrane Endothelial Keratoplasty Graft Detachment Worsening Over Time
Published 2023 - 41st Congress of the ESCRS
Reference: PP24.14 | Type: Free paper | DOI: 10.82333/k5xz-cp07
Authors: Giulia Coco* 1 , Hannah J Levis 2 , Alfredo Borgia 3 , Davide Romano 3 , Luca Pagano 3 , Gianni Virgili 4 , Stephen B Kaye 5 , Vito Romano 6
1Department of Clinical Science and Translational Medicine,University of Rome Tor Vergata,Rome,Italy;Ophthalmology,Royal Liverpool University Hospital,Liverpool,United Kingdom, 2Eye and Vision Science, Institute of Life Course and Medical Sciences,University of Liverpool,Liverpool,United Kingdom, 3Ophthalmology,Royal Liverpool University Hospital,Liverpool,United Kingdom, 4Department of Neurosciences, Psychology, Drug Research and Child Health (NEUROFARBA), Ophthalmology Clinic,University of Firenze and AOU Careggi,Florence,Italy, 5Ophthalmology,Royal Liverpool University Hospital,Liverpool,United Kingdom;Eye and Vision Science, Institute of Life Course and Medical Sciences,University of Liverpool,Liverpool,United Kingdom, 6Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, Ophthalmology Clinic,University of Brescia,Brescia,Italy;Ophthalmology,Royal Liverpool University Hospital,Liverpool,United Kingdom;Eye and Vision Science, Institute of Life Course and Medical Sciences,University of Liverpool,Liverpool,United Kingdom
Purpose
To evaluate anterior segment optical coherence tomography (AS-OCT) features of Descemet’s membrane endothelial keratoplasty (DMEK) grafts associated with graft attachment worsening over time.
Setting
St. Paul's Eye Unit, The Royal Liverpool University Hospital NHS Foundation Trust, Liverpool, United Kingdom.
Methods
Retrospective case series on patients who received uncomplicated DMEK surgery and for whom subsequent AS-OCT data were available for analysis. Patients’ demographics and surgical details were collected. AS-OCT were analysed for graft detachment axial extension, presence of posterior stromal ripples, quadrant involvement (location and number), degree of detachment extension, peripheral roll, presence and amount of air in the anterior chamber (AC). Features associated with re-bubbling and graft detachment worsening over time were identified.
Results
147 patients with mean age of 70.8±9.8 years were included. Re-bubbling was associated with posterior stromal ripples(p=0.004) and detachment axial extension(p<0.001). In initially attached grafts (n=67), risk of subsequent graft detachment was associated with posterior stromal ripples(p=0.014), recipient age(p=0.043), phaco-combined surgery(p=0.018) and AS-OCT timing(p=0.033); while in partially detached grafts (n=80), worsening was associated with posterior stromal ripples(p=0.025), detachment axial extension(p=0.003), degrees of detachment (p=0.029), peripheral roll-in(p=0.033) and air in the AC(p=0.032). Relative risk of detachment worsening in patients with moderate/severe posterior stromal ripples was 1.75(95%CI=1.09-2.81).
Conclusions
Posterior stromal ripples and detachment axial extension >1/3 of graft surface area were the main risk factors for detachment worsening over time and patients showing these features should be monitored closely to identify the need for re-bubbling at an early stage, thus improving surgical outcomes.