Morphological characteristics of graft-host interface after ultra thin Descemet stripping automated endothelial keratoplasty (UT-DSAEK): impact of Descemetorhexis technique assessed by in vivo confocal microscopy (IVCM) and anterior segment optical coherence tomography (AS-OCT).

backgroundThe graft–host interface plays a critical role in visual recovery after Ultra-Thin Descemet Stripping Automated Endothelial Keratoplasty (UT-DSAEK). This study evaluated graft–host interface morphology using quantitative Mean Grey Intensity (MGI) analysis, comparing three different Descemetorhexis techniques: ophthalmic viscosurgical device (OVD)-assisted, balanced salt solution (BSS)-assisted and air-assisted stripping. MATERIALS AND

methodsThis retrospective comparative study included 59 eyes with Fuchs’ endothelial corneal dystrophy (FECD) undergoing UT-DSAEK. According to Descemetorhexis technique, patients were divided into three groups: OVD-assisted (VISCO, n = 21), BSS-assisted (BSS, n = 20), and air-assisted (AIR, n = 18). The primary outcome was graft–host interface reflectivity, quantitatively assessed using MGI measurements obtained with ImageJ software on in vivo confocal microscopy (IVCM) and anterior segment optical coherence tomography (AS-OCT). Best-corrected visual acuity (BCVA) was evaluated as a secondary outcome. Examinations were performed at 6 and 12 months postoperatively. Longitudinal comparisons were conducted using repeated-measures analysis of variance.

resultsBCVA significantly improved over time in all groups (p < 0.001). At 6 months, the AIR group demonstrated significantly better visual acuity recovery and the lowest interface reflectivity on both IVCM and AS-OCT (p < 0.01), whereas the VISCO group exhibited the highest values on both modalities (p < 0.001). The BSS group showed intermediate results. At 12 months, reflectivity significantly decreased in all groups on both imaging modalities (p < 0.001). Although the VISCO group showed the greatest absolute reduction over time, its reflectivity values remained slightly higher than those of the AIR and BSS groups. The AIR group maintained the lowest reflectivity at both time points.

conclusionsDescemetorhexis technique is significantly related to differences in early graft–host interface morphology following UT-DSAEK. OVD-assisted stripping is associated with higher early reflectivity, whereas BSS and particularly air-assisted techniques promote faster optical clearing and visual recovery. Over time, progressive interface remodelling leads to a reduction in reflectivity across all techniques, suggesting a tendency toward long-term convergence in optical quality regardless of the intraoperative medium used.