title: A clinicopathologic series of primary graft failure after Descemet's stripping and automated endothelial keratoplasty.
abstract: OBJECTIVE
  To characterize the clinical and histologic features of primary graft failure after Descemet's stripping and automated endothelial keratoplasty (DSAEK).
  
  
  METHODS
  Retrospective observational case series.
  
  
  METHODS
  Sixteen cases of DSAEK graft failure from 15 patients, all with detailed histologic examination of failed graft tissue.
  
  
  METHODS
  Hematoxylin-eosin, periodic acid-Schiff staining, and light microscopy were used to examine the failed DSAEK graft tissue from all patients.
  
  
  METHODS
  Examination of specimens for corneal endothelial cell viability and host-donor interface characteristics.
  
  
  RESULTS
  Clinical history revealed that 88% (14/16) of studied DSAEK grafts detached before failure, and pathologic examination found that 75% (12/16) of failed grafts had atrophic corneal endothelium. Examples of residual host Descemet's membrane in the graft site and improper donor trephination were also identified.
  
  
  CONCLUSIONS
  Marked loss of the corneal endothelium is the prominent feature of primary DSAEK graft failure. Examples of surgical features, such as incomplete Descemet's stripping and residual full-thickness cornea with a DSAEK graft, are shown.
authors.affiliation: Wilmer Eye Institute, The Johns Hopkins Hospital, Baltimore, Maryland 21287, USA.
authors.forename: Stephen F
authors.initials: SF
authors.lastname: Oster
authors.forename: Katayoon B
authors.initials: KB
authors.lastname: Ebrahimi
authors.forename: Charles G
authors.initials: CG
authors.lastname: Eberhart
authors.forename: Oliver D
authors.initials: OD
authors.lastname: Schein
authors.forename: Walter J
authors.initials: WJ
authors.lastname: Stark
authors.forename: Albert S
authors.initials: AS
authors.lastname: Jun
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002452:Cell Count; D016039:Corneal Transplantation / Q000379:methods / Q000473:pathology*; D003886:Descemet Membrane / Q000473:pathology* / Q000601:surgery; D004728:Endothelium, Corneal / Q000473:pathology* / Q000637:transplantation*; D005260:Female; D005642:Fuchs' Endothelial Dystrophy / Q000601:surgery; D006084:Graft Rejection / Q000473:pathology*; D006801:Humans; D015948:Keratoplasty, Penetrating; D008297:Male; D008875:Middle Aged; D012086:Reoperation; D012189:Retrospective Studies; D014019:Tissue Donors; D017211:Treatment Failure