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Preoperative Posterior Stromal Ripples as Predictive Biomarkers of Visual Recovery After Descemet Membrane
Mariacarmela Ventura1,2, Matteo Airaldi3,4,5, Chiara Ancona1
1Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, Ophthalmology Clinic, University of Brescia, Brescia, Italy.
Purpose:
To investigate the role of preoperative posterior stromal ripples (pre-PSR) on visual acuity recovery after Descemet membrane endothelial keratoplasty (DMEK).
Methods:
This is a comparative case series retrospectively analyzing patients who underwent DMEK. Electronic records and imaging of DMEK patients were reviewed. The last preoperative and first postoperative available anterior segment optical coherence tomography scans for each eye were analyzed for the presence of pre-PSR. The difference in longitudinal trends of visual acuity recovery after DMEK was assessed in eyes with and without pre-PSR. The frequency of rebubbling and measures of proportional relative risk of rebubbling were analyzed according to the presence of preoperative and postoperative PSR.
Results:
A total of 66 patients (71 eyes) were included. Pre-PSR were associated with lower preoperative visual acuity [0.6 (0.5) vs. 0.9 (0.6) LogMAR, P = 0.02] and higher central corneal thickness [613 (73.8) vs. 715.7 (129.6) micron, P < 0.001]. Eyes with pre-PSR had a slower visual recovery up to 3.5 months after surgery compared to eyes without pre-PSR and achieved lower final visual acuity [0.1 (0.2) vs. 0.3 (0.3) LogMAR, P = 0.02]. Cox proportional hazard ratios showed that postoperative PSR were associated with a greater risk of rebubbling [hazard ratio (95% CI), 7.1 (1.3, 39.5), P = 0.02] while pre-PSR were not.
Conclusions:
The presence of pre-PSR is associated with slower visual recovery and lower final visual acuity after DMEK while postoperative PSR confer a higher risk of rebubbling. PSR represent a valuable prognostic biomarker both before and after DMEK.
Insights
Preoperative posterior stromal ripples (pre-PSR) slow visual recovery and reduce final visual acuity after Descemet membrane endothelial keratoplasty (DMEK). Postoperative PSR increase the risk of rebubbling, indicating PSR are key prognostic biomarkers.
Area of Science:
- Ophthalmology
- Corneal Surgery
- Vision Science
Background:
- Descemet membrane endothelial keratoplasty (DMEK) is a surgical procedure to restore vision.
- Posterior stromal ripples (PSR) are a corneal finding that may impact surgical outcomes.
- Understanding prognostic biomarkers is crucial for optimizing patient care in corneal transplantation.
Purpose of the Study:
- To investigate the impact of preoperative posterior stromal ripples (pre-PSR) on visual acuity recovery following DMEK.
- To evaluate the association between pre-PSR and visual outcomes after DMEK.
- To determine the prognostic value of PSR in DMEK surgery.
Main Methods:
- Retrospective comparative case series of patients undergoing DMEK.
- Analysis of anterior segment optical coherence tomography (AS-OCT) scans for pre-PSR.
- Assessment of longitudinal visual acuity recovery trends in eyes with and without pre-PSR.
- Evaluation of rebubbling frequency and risk associated with PSR.
Main Results:
- Pre-PSR were linked to lower preoperative visual acuity and increased central corneal thickness.
- Eyes with pre-PSR exhibited slower visual recovery and achieved lower final visual acuity up to 3.5 months post-DMEK.
- Postoperative PSR, but not pre-PSR, were significantly associated with an increased risk of rebubbling.
Conclusions:
- Preoperative posterior stromal ripples (pre-PSR) are associated with diminished visual recovery and final visual acuity after DMEK.
- Postoperative PSR are a significant predictor of increased rebubbling risk.
- Posterior stromal ripples (PSR) serve as valuable prognostic biomarkers before and after DMEK surgery.
