Histologic and ultrastructural findings in a case of traumatic graft failure in deep lamellar endothelial keratoplasty: a clinicopathologic case report.
OBJECTIVE
Few complications have been reported for deep lamellar endothelial keratoplasty (DLEK). Endothelial graft failure has rarely been disclosed as a complication. Although the histopathologic and ultrastructural analysis of a failed DLEK graft has been previously described, we are not aware of any reports of these features in a case of traumatic endothelial graft failure.


METHODS
We report a case of an 85-year-old man with Fuchs endothelial dystrophy who underwent DLEK for corneal decompensation after cataract extraction and intraocular lens implantation. The graft had dislocated by the fourth postoperative day and was repositioned the following day. Penetrating keratoplasty was performed 3 months later for gradually progressive intractable corneal edema. The excised cornea underwent histochemical, immunohistochemical, and ultrastructural analysis.


RESULTS
Marked endothelial loss resulting in corneal decompensation was diagnosed histopathologically. The graft-host interface line showed no substantial findings for the following histochemical and immunohistochemical stains: colloidal iron, alcian blue (pH 2.5), vimentin, epithelial membrane antigen (EMA), smooth muscle actin (SMA), anti-cytokeratin CAM 5.2, high-molecular-weight keratin, anti-cytokeratin AE1/AE3, and collagen 3. The cornea showed ultrastructural changes similar to, but more pronounced than, those observed in corneas after laser in situ keratomileusis.


CONCLUSIONS
This is the second described case of endothelial graft failure after DLEK. Histochemical and ultrastructural analysis revealed that the DLEK-operated cornea contained irregularities that may interfere with optical performance.
Gooi
Patrick
P
Department of Ophthalmology, University of Ottawa Eye Institute and The Ottawa Hospital, Ottawa, Ontario, Canada.
Robinson
Jennifer W
JW
Brownstein
Seymour
S
Rocha
Guillermo
G
D000369:Aged, 80 and over; D015415:Biomarkers / Q000378:metabolism; D002452:Cell Count; D015715:Corneal Edema / Q000209:etiology / Q000601:surgery; D016039:Corneal Transplantation / Q000009:adverse effects*; D004728:Endothelium, Corneal / Q000378:metabolism / Q000637:transplantation* / Q000648:ultrastructure*; D005136:Eye Proteins / Q000378:metabolism; D005642:Fuchs' Endothelial Dystrophy / Q000601:surgery; D006084:Graft Rejection / Q000209:etiology / Q000378:metabolism / Q000473:pathology* / Q000601:surgery; D006801:Humans; D015948:Keratoplasty, Penetrating; D008297:Male
D015415:Biomarkers; D005136:Eye Proteins