Purpose. To examine the graft-host interface during Descemet's stripping automated endothelial keratoplasty (DSAEK) surgery with optical coherence tomography (OCT). Design. Prospective, interventional case series. Patients and Methods. Eight patients who underwent a DSAEK were included. A handheld OCT was used intraoperatively to examine the presence of interface fluid between the host cornea and the graft. Results. In 3 patients, no interface fluid was detected between the host cornea and the graft after the graft was attached by air injection. In 4 patients, interface fluid was detected after the graft was attached by air injection. The remaining interface fluid was drained through corneal stab incisions. One patient required a second surgery because the first surgery failed due to persistence of the interface fluid. All patients showed a complete attachment of the graft at one month after the DSAEK surgery. Conclusion. A handheld OCT is useful to detect the interface fluid between the host cornea and the graft during a DSAEK. 1. Introduction Penetrating keratoplasty has mainly been performed for the treatment of bullous keratopathy and other diseases with corneal endothelial dysfunction. Recently, DSAEK (Descemet’s stripping automated endothelial keratoplasty) has been performed as a primary surgical treatment for such diseases [1–3]. And although DSAEK is more advantageous for the recovery of visual acuity than penetrating keratoplasty, its complications include postoperative graft detachment and graft dislocation [1–7]. The rates of these complications vary between 4% and 50% [1–7]. Several studies have been conducted to identify a means of preventing the graft-host interface from being detached or being dislocated intraoperatively or postoperatively [8–10]. Two of these studies reported that anterior segment optical coherence tomography (OCT) is useful to assess the status of the graft-host interface [8, 10]. In this study, therefore, we prospectively examined the graft-host interface during a DSAEK with a handheld OCT. 2. Materials and Methods We included 8 eyes of 8 consecutive patients (3 men and 5 women) who underwent DSAEK for the treatment of bullous keratopathy at Toyama University Hospital between October 2010 and February 2012. The study protocol was approved by the Institutional Review Board of the University of Toyama, and the procedures used conformed to the tenets of the Declaration of Helsinki. Each patient provided written informed consent after hearing a detailed explanation of the study protocol. In this study, the cornea and the
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