title: In vivo laser confocal microscopy after Descemet's membrane endothelial keratoplasty.
abstract: OBJECTIVE
  To investigate the in vivo corneal changes in patients with bullous keratopathy who underwent Descemet's membrane endothelial keratoplasty (DMEK) with the use of in vivo laser confocal microscopy.
  
  
  METHODS
  Single-center, retrospective clinical study.
  
  
  METHODS
  Five eyes of 4 patients (3 men, 1 women; mean age, 61.3 ± 9.6 years) with bullous keratopathy who had undergone successful DMEK were enrolled in this study.
  
  
  METHODS
  In vivo laser confocal microscopy was performed before and 1, 3, and 6 months after DMEK.
  
  
  METHODS
  Selected confocal images of corneal layers were evaluated qualitatively and quantitatively for the degree of haze and the density of deposits. Subepithelial haze, donor-recipient interface haze, donor-recipient interface particles, and host stromal needle-shaped materials were graded on a scale of 4 categories (grade 0 = none, grade 1 = mild, grade 2 = moderate, grade 3 = severe) at each time point. Time trends of the outcomes were graphically displayed and evaluated with Mantel-Haenszel trend test.
  
  
  RESULTS
  The following were observed preoperatively in all patients: slight corneal epithelial edema, moderate subepithelial haze, keratocytes in a honeycomb pattern, and tiny needle-shaped materials in the stroma. After DMEK, moderate subepithelial haze persisted during the follow-up period. Needle-shaped materials had a tendency to decrease after DMEK. Most notably, donor-recipient interface haze and donor-recipient interface particles were barely noticeable after DMEK as early as 1 month postoperatively.
  
  
  CONCLUSIONS
  In vivo laser confocal microscopy can identify subclinical corneal abnormalities after DMEK, such as subepithelial haze, host stromal needle-shaped materials, and minimum donor-recipient interface haze/particles. These abnormalities seemed subtle compared with Descemet stripping automated endothelial keratoplasty; this may explain the superior postoperative visual acuity after DMEK. Further studies with this technology in a large number of patients and long-term follow-up are needed to fully understand the long-term corneal changes after DMEK.
  
  
  BACKGROUND
  The author(s) have no proprietary or commercial interest in any materials discussed in this article.
authors: Department of Ophthalmology, Kanazawa University Graduate School of Medical Science, Kanazawa, Ishikawa-ken, Japan. kobaya@kenroku.kanazawa-u.ac.jp
authors: Akira
authors: A
authors: Kobayashi
authors: Hideaki
authors: H
authors: Yokogawa
authors: Natsuko
authors: N
authors: Yamazaki
authors: Toshinori
authors: T
authors: Masaki
authors: Kazuhisa
authors: K
authors: Sugiyama
mesh_terms: D000368:Aged; D003316:Corneal Diseases / Q000473:pathology / Q000601:surgery*; D057111:Descemet Stripping Endothelial Keratoplasty; D005260:Female; D006801:Humans; D008297:Male; D018613:Microscopy, Confocal / Q000379:methods*; D008875:Middle Aged; D011184:Postoperative Period; D012189:Retrospective Studies; D014792:Visual Acuity