Screening and Grading of Textural Interface Opacities in DSAEK Grafts for Predicting Visual Outcomes

BACKGROUND: Textural Interface Opacities (TIO) following Descemet's Stripping Automated Endothelial Keratoplasty (DSAEK) have become a notable postoperative concern. Several studies have attempted to identify associations between TIO development and intraoperative factors, in-cluding fluid dynamics, irregular stromal surfaces, viscoelastic usage, and recipient immunological responses. Despite these efforts, the precise etiology of TIO remains uncertain. METHODS: Optical Coherence Tomography (OCT) images of DSAEK-processed corneal grafts, prepared using the same microkeratome and technique for transplantation at the Bascom Palmer Eye Institute, underwent blinded analysis using a newly developed grading scale. This analysis focused on DSAEK-processed grafts OCT images to evaluate and categorize the occurrence of TIO and assess the final visual acuity of the patients at the 1-year postoperative evaluation. RESULTS: The study included 221 donor corneas transplanted from 2019 to 2023. Greater TIO based on “M-TIO” grading scale was associated with worse recipient logMAR VA (Mean 0.151 [99% CI: 0.077 to 0.225] for corneas with no TIO increased to 0.680 [99% CI: 0.532 to 0.828] for corneas with the greatest TIO grade). CONCLUSION: This study introduces “M-TIO” grading scale for screening TIO in corneal grafts prior to DSAEK transplantation. Our findings demonstrate a significant association between the presence of TIO identified in OCT images of DSAEK-processed corneal grafts and transplantation outcomes.