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Updated: Jun 21, 2026
An “All-laser” Endothelial Transplant
Published on: July 6, 2015
In vivo laser confocal microscopy after non-Descemet's stripping automated endothelial keratoplasty
Akira Kobayashi1, Hideaki Yokogawa, Kazuhisa Sugiyama
1Department of Ophthalmology, Kanazawa University Graduate School of Medical Science, Kanazawa, Japan. kobaya@kenroku.kanazawa-u.ac.jp
Objective:
To investigate in vivo corneal changes in patients with bullous keratopathy who underwent non-Descemet's stripping automated endothelial keratoplasty (nDSAEK) with the use of laser confocal microscopy.
Design:
Single-center, prospective clinical study.
Participants:
Ten eyes (10 patients; 3 men and 7 women; mean age, 73.5+/-6.6 years [mean+/-standard deviation]) with bullous keratopathy were evaluated in this study.
Testing:
In vivo laser confocal microscopy was performed before and 1, 3, and 6 months after nDSAEK.
Main Outcome Measures:
Selected confocal images of corneal layers were evaluated qualitatively and quantitatively for degree of haze and density of deposits.
Results:
Before surgery, the following were observed in all patients: corneal epithelial edema, subepithelial haze, keratocytes in a honeycomb pattern, and tiny needle-shaped materials in the stroma. After nDSAEK, subepithelial haze, donor-recipient interface haze, and interface particles were observed in all measurable cases; postoperative haze, interface particles, and needle-shaped materials decreased statistically significantly (P<0.05) over the course of follow-up. In addition, hyperreflective giant interface particles were observed after nDSAEK in all patients.
Conclusions:
In vivo laser confocal microscopy can identify subclinical corneal abnormalities after nDSAEK such as subepithelial haze, host-recipient interface haze, host stromal needle-shaped materials, and host-recipient interface particles with characteristic giant particles. Further studies with this technology in a large number of patients and long-term follow-up are needed to understand fully the long-term corneal stromal changes after nDSAEK.
