Optical Coherence Tomography Anatomy of the Corneal Endothelial Transplantation Wound

PURPOSE:The goal of this study was to prospectively assess the deep lamellar endothelial keratoplasty (DLEK) wound anatomy and its evolution during the 12 months after surgery, using optical coherence tomography (OCT). METHODS:The eyes of 8 patients (1 eye per patient) who consecutively underwent DLEK for Fuchs dystrophy or pseudophakic bullous keratopathy were prospectively studied before and 1, 3, 6, and 12 months after surgery. The Stratus OCT apparatus (Carl Zeiss Meditec, Dublin, CA) was used to acquire central and radial scans perpendicular to the wound at 3-, 6-, 9-, and 12-oʼclock positions. The following parameters were analyzedcentral total thickness, posterior donor-recipient edges gap, donor-recipient height mismatch, tissue compression, and graft detachment. RESULTS:A posterior gap was observed in 4 of the 8 DLEK eyes. At 12 months, the mean gap contour, depth, and width were 242 ± 67, 101 ± 45, and 87 ± 29 μm, respectively. A step was documented in all DLEK eyes (average step height 108 ± 24 μm). A micrograft detachment was observed in one case and tissue compression in another. In all corneas, the mean central corneal thickness returned to normal range and almost normal anatomy with time after surgery. CONCLUSIONS:OCT was found to be a very useful tool for DLEK corneal wound architecture analysis. It revealed microscopic wound irregularities and allowed their quantitative follow-up with time.