Descemet’s membrane area and posterior corneal power may predict the Descemet membrane folds after deep anterior lamellar keratoplasty in patients with advanced keratoconus

Abstract

Aims: To investigate possible predictive topographic characteristics for the development of Descemet’s membrane (DM) folds after the uneventful deep anterior lamellar keratoplasty (DALK). Methods: A retrospective study included 56 eyes of 56 consecutive patients who underwent uneventful DALK using the big-bubble technique to treat advanced keratoconus. At baseline and each visit, best-corrected logMAR visual acuity (BCVA), slit-lamp findings, endothelial cell density, topographic parameters were recorded. DM area is calculated using morphogeometric modelling. Results: Twelve (21.4%) of them exhibited DM folds, whereas the remaining 44 (78.6%) did not exhibit any DM folds after the surgery. The mean follow-up time was 36.3 ± 16.7 (range, 12–71) months. The mean posterior corneal power was − 13.8 ± 0.6 D in patients with DM folds, whereas − 13.0 ± 0.8 D in those without DM folds (p = 0.016). The mean DM area was 53.6 ± 2.3 (50.9–57.9) mm2 in patients with DM folds, whereas 51.6 ± 1.7 (47.1–53.9) mm2 in those without DM folds (p = 0.001). The ROC curve showed that two best cut-off value for the posterior corneal power and DM area were 13.75 D and 53.8 mm2, respectively, to predict the occurrence of DM folds. Conclusion: DALK surgery seems to cause DM folds in patients with large DM area and high posterior corneal power.