In vivo laser confocal microscopy after Descemet stripping with automated endothelial keratoplasty

PURPOSE: To investigate in vivo corneal changes in patients with bullous keratopathies before and after Descemet stripping with automated endothelial keratoplasty (DSAEK) using laser confocal microscopy. DESIGN: Single-center, prospective, comparative clinical study. METHODS: Seven patients (two men, five women; mean age, 68.9 years; range, 59 to 78) with bullous keratopathies who underwent DSAEK enrolled in this study. Laser confocal microscopy was performed before and one, three, and six months after DSAEK. Selected images were evaluated qualitatively and quantitatively for degree of haze and density of deposits. RESULTS: Preoperatively, corneal epithelial edema, subepithelial haze, keratocytes in a honeycomb pattern, and tiny needle,shaped materials in the stroma were observed in all patients. After DSAEK, subepithelial haze, donor,recipient interface haze, and interface particles were observed in all five measurable cases; postoperative haze and particles decreased statistically significantly (P < .05) over follow,up. CONCLUSIONS: In vivo laser confocal microscopy is capable of identifying subclinical corneal abnormality after DSAEK with high resolution. Further studies in a large number of patients and long-term follow-up after DSAEK using this device are needed to fully understand long-term corneal stromal changes after DSAEK and whether the preexisting corneal stromal pathologies are reversible.