CLINICAL SCIENCE Monitoring Cornea and Graft Morphometric Dynamics After Descemet Stripping and Endothelial Keratoplasty With Anterior Segment Optical Coherence Tomography Dorota Tarnawska, MD and Edward Wylegala, MD, PhD Purpose: To evaluate the dynamics of cornea and graft thickness after Descemet stripping and endothelial keratoplasty (DSEK) using anterior segment optical coherence tomography (AS-OCT) and to assess the usefulness of AS-OCT in monitoring graft adherence after DSEK. Methods: Eighty-eight eyes from 86 patients underwent DSEK for Fuchs endothelial dystrophy or pseudophakic bullous keratopathy. Central corneal thickness (CCT), endothelial graft thickness (GT), interface fluid presence, graft dislocation, rate of CCT, and GT changes were measured with an AS-OCT during 12-month follow up. Results: The CCT averaged 788 mm preoperatively. On post- operative Day 1, mean CCT was 816 mm and GT was 191 mm. Compared with CCT on the first day, the changes in CCT on 2, 3, and 7 days were statistically nonsignificant. From 1 month to 12 months after DSEK, the CCT significantly diminished (P , 0.001). The CCT dynamics closely correlated with changes of GT and of the recipient’s part of cornea. The most rapid rate of thickness decrease was observed between 1 week and 1 month: 5.34 mm/day for the entire cornea and 2.54 mm/day for endothelial disc. Between 1 month and 1 year, the CCT and GTwere stable with only a trend toward further decrease. Entrapped fluid at graft/host interface on the first postoperative day was detectable by slit-lamp examination in 14 eyes (16%) and in 28 eyes (32%) in OCT. Conclusion: The recovery of endothelial pump after DSEK takes place between 1 week and 1 month after DSEK. AS-OCT can be practically used for evaluation of the cornea dynamics as well as for the qualitative and quantitative assessment of graft-host interface after DSEK. Key Words: endothelial keratoplasty, AS-OCT, corneal thickness, graft/host interface (Cornea 2010;29:272–277) T he field of lamellar surgery has rapidly advanced over the last decade, particularly posterior lamellar surgery for endothelial dysfunction. Unlike penetrating keratoplasty, this still-evolving technique spares the healthy anterior portion of cornea, thereby maintaining the integrity of the eye. Selective replacement of the dysfunctional host endothelium eliminates crucial disadvantages of full-thickness transplantation and allows for faster visual rehabilitation. 1–5 Regardless of the method used for the donor cornea dissection, eg, manual (deep lamellar endothelial keratoplasty [DLEK]; Descemet stripping endothelial keratoplasty [DSEK]) or microkeratome (Desce- met stripping automated endothelial keratoplasty [DSAEK]), a precise assessment of donor tissue adhesion in the early postoperative period is helpful for preventing graft detach- ment, which is the most common complication. 6–9 Optical coherence tomography (OCT) is a high-resolution technique for obtaining precise cross-sectional images of the anterior and posterior segments of the eye. Anterior segment OCT (AS-OCT), customized for anterior segment evaluation, allows for the accurate identification, monitoring, and quan- titative assessment of corneal thickness across the entire corneal surface and for the measurement of ophthalmic parameters in the anterior chamber. 10,11 We consider AS-OCT especially useful for postoperative measurements of the host cornea and graft thickness and assessment of the graft/host interface in all anterior and posterior lamellar keratoplasty techniques and have therefore performed this examination since 2006. We presented this application for AS-OCT in 2006 12 and, to our knowledge, before that time, there were no publications on the practical use of AS-OCT for evaluating the corneal sublayers after endothelial keratoplasty. We report the practical use of AS-OCT as a standard examination in a series of patients with Fuchs dystrophy and bullous keratopathy undergoing DSEK. The imaging was useful for determining grafts that either progressed to detach- ment or spontaneous interface fluid absorption. Systematic imaging allowed us to monitor the dynamics of the corneal and graft thickness and to determine the time point at which the new endothelial barrier became stabilized. PATIENTS AND METHODS This prospective study was designed as a consecutive, interventional case series. Eighty-eight consecutive eyes from 86 patients (68 women, 18 men) with vision loss resulting Received for publication September 29, 2009; revision received June 19, 2009; accepted July 2, 2009. From the Ophthalmology Department, Okregowy Szpital Kolejowy, Poland. The authors have no financial, commercial, or proprietary interest in any of the products, instruments, or devices mentioned in this article. Reprints: Dorota Tarnawska, MD, Okregowy Szpital Kolejowy, ul. Panewnicka 65, 40-760 Katowice Poland (e-mail: dorota.tarnawska@ gmail.com). Copyright Ó 2010 by Lippincott Williams & Wilkins 272 | www.corneajrnl.com Cornea  Volume 29, Number 3, March 2010