Chatzea Marina S, Kymionis George D, Vakalopoulos Dionysios G, O'Brien Robert C, Mora Daniella, Llanes Katrina, Fout Elizabeth, Buras William, Triglia Concetta, Tonk Rahul S, Yoo Sonia H
1st Department of Ophthalmology, "G. Gennimatas" Hospital, National and Kapodistrian University of Athens, 11527 Athens, Greece.
Miller School of Medicine, University of Miami, Miami, FL 33136, USA.
Diagnostics (Basel). 2025 Jun 25;15(13):1608. doi: 10.3390/diagnostics15131608.
: Textural interface opacities (TIOs) following Descemet's stripping automated endothelial keratoplasty (DSAEK) have become a significant postoperative concern. Studies have explored possible links such as stromal irregularities and viscoelastic usage, but the exact cause of TIOs remains unclear. PURPOSE: To evaluate the relationship between microkeratome dissection parameters and the development of textural interface opacities in DSAEK grafts utilizing the "M-TIO" grading scale for standardized assessment. : Optical coherence tomography (OCT) images of DSAEK-processed corneal grafts, prepared with the same microkeratome and technique for transplantation at Bascom Palmer Eye Institute, underwent blinded analysis using a newly developed grading scale termed "M-TIO". This analysis aimed to evaluate and categorize the occurrence of TIO, explore its potential correlation with graft characteristics prior to DSAEK preparation, and assess specific stages of the DSAEK dissection process. Data collected included the size of the microkeratome head used, the difference between the head and the actual stromal cut, and the difference between the pre-cut graft thickness and post-cut DSAEK lenticule thickness. : The study retrospectively included 422 donor corneas transplanted from 2019 to 2023. Variables associated with TIO in the final multivariable ordinal logistic model included the difference between the pre-cut graft thickness and the post-cut DSAEK lenticule thickness (OR: 1.57 [99% CI: 1.22 to 2.06] per 50 µm) and microkeratome head (OR: 6.95 [99% CI: 1.04 to 36.60] 300 µm, OR: 4.39 [99% CI: 0.76 to 19.00] 350 µm, and OR: 18.86 [99% CI: 2.35 to 175.91] 400 µm vs 450 or 500 µm, respectively). : This study identified a statistically significant association between TIOs and the microkeratome DSAEK preparation, proposing several factors that could help prevent its occurrence. Specifically, creating an ultra-thin DSAEK lenticule from an initially thick graft using a smaller microkeratome head with the slow single-pass technique may increase the risk of TIOs. In contrast, utilizing a larger microkeratome head can improve stromal thickness consistency, reduce technical challenges during graft preparation, and lower the risk of TIOs.
在Descemet膜剥离自动内皮角膜移植术（DSAEK）后出现的纹理界面混浊（TIOs）已成为术后的一个重要问题。研究探索了诸如基质不规则和粘弹性使用等可能的联系，但TIOs的确切原因仍不清楚。目的：利用“M-TIO”分级量表进行标准化评估，以评估微型角膜刀切割参数与DSAEK移植物中纹理界面混浊发展之间的关系。：在Bascom Palmer眼科研究所，使用相同的微型角膜刀和移植技术制备的DSAEK处理的角膜移植物的光学相干断层扫描（OCT）图像，采用一种新开发的名为“M-TIO”的分级量表进行盲法分析。该分析旨在评估和分类TIO的发生情况，探索其与DSAEK制备前移植物特征的潜在相关性，并评估DSAEK切割过程的特定阶段。收集的数据包括所使用的微型角膜刀头的尺寸、刀头与实际基质切割之间的差异，以及切割前移植物厚度与切割后DSAEK透镜厚度之间的差异。：该研究回顾性纳入了2019年至2023年移植的422个供体角膜。最终多变量有序逻辑模型中与TIO相关的变量包括切割前移植物厚度与切割后DSAEK透镜厚度之间的差异（每50μm的比值比：1.57 [99%置信区间：1.22至2.06]）和微型角膜刀头（300μm的比值比：6.95 [99%置信区间：1.04至36.60]，350μm的比值比：4.39 [CI：0.76至19.00]，400μm与450或500μm相比的比值比：18.86 [99%置信区间：2.35至175.91]）。：本研究确定了TIOs与微型角膜刀DSAEK制备之间存在统计学上的显著关联，提出了几个有助于预防其发生的因素。具体而言，使用较小的微型角膜刀头和缓慢的单次通过技术从最初较厚的移植物中制作超薄的DSAEK透镜可能会增加TIOs的风险。相比之下，使用较大的微型角膜刀头可以提高基质厚度的一致性，减少移植物制备过程中的技术挑战，并降低TIOs的风险。
