Combined specular microscopy and Scheimpflug imaging to improve detection of an upcoming allograft rejection after DMEK

Autor: Diana Santander-García, Lisanne Ham, Gerrit R. J. Melles, Marieke Bruinsma, Silke Oellerich, Lamis Baydoun
Jazyk: angličtina
Rok vydání: 2020
Předmět:
Adult
Graft Rejection
Male
specular microscopy
medicine.medical_specialty
Time Factors
Descemet membrane
genetic structures
Scheimpflug principle
03 medical and health sciences
0302 clinical medicine
Descemet membrane endothelial keratoplasty
Ophthalmology
Cell density
Retrospective analysis
Medicine
Humans
Transplantation
Homologous
Aged
Retrospective Studies
Aged
80 and over
Microscopy
business.industry
allograft rejection
Endothelium
Corneal
endothelial cell density
Scheimpflug imaging
General Medicine
Organ Preservation
Middle Aged
eye diseases
Endothelial cell density
Steroid therapy
Allograft rejection
Case-Control Studies
SPECULAR MICROSCOPY
030221 ophthalmology & optometry
pachymetry
Female
sense organs
business
030217 neurology & neurosurgery
Descemet Stripping Endothelial Keratoplasty
Tomography
Optical Coherence
Zdroj: Acta Ophthalmologica, 98(3), 261-266. WILEY
Popis: Purpose To assess whether combined analysis of specular microscopy and Scheimpflug imaging improves detection of an upcoming allograft rejection following Descemet membrane endothelial keratoplasty (DMEK). Methods Retrospective analysis of 22 eyes that had developed a clinical proven allograft rejection 28 (±22) months (range: 4-84 months) after DMEK. Specular microscopy and Scheimpflug images routinely made after DMEK were retrospectively analysed for changes in endothelial cell morphology (e.g. nuclear activation), cell density (>10%) and pachymetry (>7%), and/or the presence of subclinical keratic precipitates. The same parameters were evaluated for 22 control eyes matched for age, gender and surgery indication. Results A total of 20/22 eyes (91%) showed detectable changes 0.25-75 months before allograft rejection became clinically manifest: 13/22 (59%) showed both specular microscopy and Scheimpflug imaging changes; 5/22 (23%) only had changes on Scheimpflug imaging; and 2/22 (9%) only had specular microscopy changes. In 18/22 (82%) and 14/22 (64%) eyes, subclinical keratic precipitates and endothelial cell morphology changes could be detected, respectively. A total of 11/22 (50%) eyes concurrently showed a >10% drop in endothelial cell density and 4/22 (18%) a >7% pachymetry increase. Of the control eyes, 7/22 (32%) showed changes with specular microscopy but not with Scheimpflug imaging. Conclusions Combined analysis of specular microscopy and Scheimpflug imaging may allow recognizing an upcoming allograft rejection in over 90% of eyes and up to 6 years before rejection becomes clinically manifest. Early recognition of eyes at risk may allow for targeted intensified steroid treatment to prevent endothelial cell damage associated with rejection.
Databáze: OpenAIRE
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