title: 360-Degree Scheimpflug Imaging to Predict Allograft Rejection After Descemet Membrane Endothelial Keratoplasty.
abstract: OBJECTIVE
  To describe the use of 360-degree Scheimpflug imaging as a diagnostic tool for detection and documentation of subtle corneal changes preceding upcoming allograft rejection after Descemet membrane endothelial keratoplasty (DMEK).
  
  
  METHODS
  A total of 17 eyes (16 patients) were diagnosed with clinically manifest allograft rejection 2 to 42 months after DMEK. 360-degree Scheimpflug images of consecutive follow-up examinations (from 3-60 mo) of "asymptomatic" eyes before, during, and after rejection were retrospectively analyzed, to determine which abnormalities could be detected before allograft rejection became clinically manifest. The images were compared with DMEK control eyes (without rejection episode).
  
  
  RESULTS
  Scheimpflug images at the time of rejection showed keratic precipitates as distinct retrocorneal nodular elevations and/or a significant increase in pachymetry of ≥7%. More subtle changes could be identified retrospectively in 9/17 eyes (53%) on an average at 8 (±5) months before rejection became clinically manifest; in all eyes, these subtle changes were not recognized at routine slit-lamp examinations by various ophthalmologists as inflammatory changes heralding allograft rejection. Secondary graft failure occurred in 4/17 eyes (24%). None of the control eyes showed relevant abnormalities with Scheimpflug imaging.
  
  
  CONCLUSIONS
  By screening the posterior corneal surface with 360-degree Scheimpflug imaging, subtle inflammatory retrocorneal deposits can be detected and recorded during consecutive follow-up visits. Hence, Scheimpflug imaging may have the potential to become a diagnostic tool for early detection of upcoming allograft rejection in asymptomatic DMEK eyes, that is, before the immune response becomes clinically manifest and before substantial endothelial cell damage occurs.
authors: *Netherlands Institute for Innovative Ocular Surgery, Rotterdam, the Netherlands; †Melles Cornea Clinic, Rotterdam, the Netherlands; and ‡Amnitrans EyeBank, Rotterdam, the Netherlands.
authors: Lamis
authors: L
authors: Baydoun
authors: Eitan
authors: E
authors: Livny
authors: Lisanne
authors: L
authors: Ham
authors: Marieke
authors: M
authors: Bruinsma
authors: Gerrit R J
authors: GR
authors: Melles
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D064591:Allografts; D003316:Corneal Diseases / Q000601:surgery; D063171:Corneal Pachymetry; D057111:Descemet Stripping Endothelial Keratoplasty; D003952:Diagnostic Imaging / Q000379:methods*; D003941:Diagnostic Techniques, Ophthalmological; D005260:Female; D006084:Graft Rejection / Q000000981:diagnostic imaging*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D014019:Tissue Donors