Evaluating Scheimpflug Imaging As An Alternative To Anterior Segment Oct For Assessing Post-Keratoplasty Graft Attachment
Published 2025 - 43rd Congress of the ESCRS
Reference: PO938 | Type: Poster | DOI: 10.82333/87yt-jw78
Authors: Imran Karim Janmohamed* 1 , Raffaele Piscopo 1 , Mustafa Ali 1 , Ghulam Mustafa Majeed 2 , Sundas Maqsood 1 , Mohamed Elalfy 3
1Ophthalmology,Maidstone and Tunbridge Wells NHS Trust,Maidstone,United Kingdom, 2Ophthalmology,Peterborough City Hospital,Peterborough,United Kingdom, 3Ophthalmology,Maidstone and Tunbridge Wells NHS Trust,Maidstone,United Kingdom;Corneoplastic Unit and Eye Bank,Queen Victoria Hospital NHS Foundation Trust,East Grinstead,United Kingdom;Cornea Unit,Research Institute of Ophthalmology,Giza,Egypt
Purpose
Graft detachment remains a significant post-operative complication following descemet stripping endothelial keratoplasty/Descemet stripping automated endothelial keratoplasty (DSEK/DSAEK), and descemet membrane endothelial keratoplasty (DMEK). While anterior segment optical coherence tomography (AS-OCT) is considered the gold standard for evaluating graft attachment, Scheimpflug imaging offers an alternative imaging modality. This study aimed to compare the effectiveness of these imaging techniques in assessing post-operative graft attachment.
Setting
Department of Ophthalmology, Maidstone and Tunbridge Wells NHS Trust, Maidstone, Kent, United Kingdom
Methods
In this single-centre retrospective study, we examined patients who underwent endothelial keratoplasties between January 2018 and January 2024. Post-operative imaging was performed using AS-OCT (Topcon DRI OCT Triton) and Scheimpflug imaging (Pentacam HR). Two independent masked observers evaluated images for graft attachment. Inter-observer agreement was assessed using Cohen's kappa coefficient.
Results
40 eyes from 38 patients were included. Of 76 paired scans analysed, AS-OCT achieved perfect inter-observer agreement (κ=1.000), while Scheimpflug imaging demonstrated fair agreement (κ=0.243). For Scheimpflug imaging, observers agreed in 53/76 (69.7%) cases. In the 53 cases with observer consensus, Scheimpflug imaging showed high sensitivity (97.5%) but moderate specificity (46.2%) compared to AS-OCT, with positive and negative predictive values of 84.8% and 85.7%, respectively.
Conclusions
AS-OCT demonstrated superior reliability in post-keratoplasty graft assessment, achieving perfect inter-observer agreement. While Scheimpflug imaging showed potential utility with high sensitivity, its lower specificity and observer concordance limit its clinical application. These findings support AS-OCT as the optimal imaging modality for post-keratoplasty graft assessment, though practical considerations regarding resource allocation remain important.