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. 2016 Apr-Jun;30(2):98-104.
doi: 10.1016/j.sjopt.2016.01.003. Epub 2016 Jan 28.

Morphometric changes of corneal endothelial cells following intracameral air for micro perforation of the Descemet Membrane during big-bubble deep anterior lamellar keratoplasty

Ashbala Khattak  1 , Fouad R Nakhli  2 , Hussam Mohammad Abdullatif Abouollo  3
Affiliations

Morphometric changes of corneal endothelial cells following intracameral air for micro perforation of the Descemet Membrane during big-bubble deep anterior lamellar keratoplasty

Ashbala Khattak et al. Saudi J Ophthalmol. 2016 Apr-Jun.

Abstract

Aim: The aim of this study was to assess the effect of intracameral air on the endothelial cell morphometrics.

Patients and methods: This is a retrospective controlled interventional cohort study of 26 patients (18 males and 8 females) who underwent unilateral deep anterior lamellar keratoplasty (DALK) for moderate keratoconus. The DALK patients were divided into two groups: a treatment group (14), which had micro perforations of the Descemet Membrane (DM) intraoperatively and received intracameral air at the end of the surgery; and an independent control group (12), which had no micro perforation and thus no intracameral air was injected. Postoperative best corrected visual acuity (BCVA), sphere, cylinder, spherical equivalent (SEQ), central corneal thickness, and endothelial cell morphometric features consisted of the endothelial cell density (ECD), polymegathism, and pleomorphism were compared between treatment and control groups.

Results: The mean BCVA was 0.36 ± 0.36 logMAR in the treatment group and 0.17 ± 0.11 logMAR in the control group (p = 0.081), and the mean corneal thickness was 507.86 ± 62.69 μm in the treatment group and 525.67 ± 37.54 μm in the control group air (p = 0.399). Furthermore, the mean sphere was -5.14 ± 4.17D and -1.02 ± 3.29D, the mean cylinder was -3.16 ± 2.20D and -2.88 ± 1.21D, and the mean SEQ was -6.72 ± 4.66D and -2.46 ± 3.14D and in the treatment and control groups respectively (p = 0.011, 0.693, and 0.013). As to morphometric features, the mean ECD was 2176.76 ± 549.18 cell/mm(2) and 2257.30 ± 436.12 cell/mm(2) in the treatment and control groups respectively (p = 0.686), and the mean pleomorphism 0.48 ± 0.09 and 0.54 ± 0.10 in the treatment and control groups respectively (p = 0.139). In contrast, the mean polymegathism was 0.37 ± 0.06 and 0.31 ± 0.05 in the treatment and control groups respectively (p = 0.009).

Conclusion: The presence of air inside the anterior chamber for a short term may not cause further endothelial cell loss and can be safely performed to prevent postoperative Descemet Membrane detachment in case of micro perforations.

Keywords: Endothelial cell density; Keratoconus; Keratoplasty; Pleomorphism; Polymegathism.

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Figures

Figure 1
Figure 1
The distribution of the best corrected visual acuity in the treatment and the control groups.
Figure 2
Figure 2
The distribution of the spherical equivalent in the treatment and the control groups.
Figure 3
Figure 3
The distribution of the endothelial cell density in the treatment and the control groups.
Figure 4
Figure 4
The distribution of the pleomorphism in the treatment and the control groups.
Figure 5
Figure 5
The distribution of the polymegathism in the treatment and the control groups.
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