PARIS — Combined assessment of specular microscopy and Scheimpflug imaging could aid in detecting eyes at risk for graft rejection following Descemet’s membrane endothelial keratoplasty, according to a study presented here.
“The risk of allograft rejection has decreased significantly with DMEK surgery, and the form of rejection is much milder, but still, you have cell loss with rejection, so potentially these eyes can experience secondary graft failure,” Lamis Baydoun, MD, of the University Hospital Münster, Germany, and the ELZA Institute, Switzerland, said at EuCornea 2019.
In a retrospective review of specular microscopy and Scheimpflug imaging data for 1,077 eyes that underwent DMEK, 27 eyes of 26 patients developed graft rejection. In 20 eyes, changes were seen on specular microscopy, Scheimpflug imaging or both; in two eyes, no changes were seen. Five eyes were excluded from analysis.
The main finding in the rejection group was subclinical keratic precipitates in 18 eyes, followed by endothelial cell changes in 14 eyes.
Scheimpflug imaging and specular microscopy data for 22 eyes that underwent DMEK and were not rejected were also obtained.
“In the control eyes, we saw that changes were only visible on specular microscopy, which was interesting, whereas we did not see any changes with the Scheimpflug tomography,” Baydoun said. The specular microscopy changes were seen in seven of the control eyes.
“The question is here, is maybe Scheimpflug imaging more specific for rejection eyes? And you have to take into account that these changes, even though visible, were lower in scores,” Baydoun said. “In conclusion, these two methods might help us identify eyes at risk of rejection in the future, and this may help us to target these patients with intensified topical treatments.” – by Patricia Nale, ELS
Baydoun L. Combined specular microscopy and Scheimpflug imaging to improve detection of an upcoming allograft rejection after Descemet membrane endothelial keratoplasty (DMEK). Presented at: EuCornea; Sept. 13-14, 2019; Paris.
Disclosure: Baydoun reports financial relationships with DORC International/Dutch Ophthalmic USA.