title: Epithelial downgrowth after Descemet-stripping automated endothelial keratoplasty.
abstract: A 66-year-old man presented with decreased vision and corneal edema after 2 failed Descemet-stripping automated endothelial keratoplasty (DSAEK) graft procedures in the left eye. An uneventful third DSAEK procedure combined with anterior vitrectomy through the previous limbal wound was performed. Postoperative recovery was uneventful. Histopathology of the excised failed graft revealed conjunctival epithelium on the posterior surface of the tissue. At 1 year, the endothelial cell count was 1997 cells/mm(2) and the uncorrected visual acuity was 20/20(-2). At 18 months, the graft remained clear with no signs of epithelial downgrowth. Clinicians should be aware that epithelial downgrowth can occur following DSAEK surgery. Fortunately, excision of the prior DSAEK graft with removal of the active epithelial membrane appears to have been a successful treatment in this patient.
authors.affiliation: Devers Eye Institute, 1040 Northwest 22nd Avenue, Portland, Oregon 97210, USA. paulphillipsmd@gmail.com
authors.forename: Paul M
authors.initials: PM
authors.lastname: Phillips
authors.forename: Mark A
authors.initials: MA
authors.lastname: Terry
authors.forename: Stephen C
authors.initials: SC
authors.lastname: Kaufman
authors.forename: Edwin S
authors.initials: ES
authors.lastname: Chen
mesh_terms: D002452:Cell Count; D003228:Conjunctiva / Q000473:pathology*; D015715:Corneal Edema / Q000209:etiology; D016039:Corneal Transplantation; D003886:Descemet Membrane / Q000601:surgery*; D004728:Endothelium, Corneal / Q000637:transplantation*; D004847:Epithelial Cells / Q000473:pathology*; D005642:Fuchs' Endothelial Dystrophy / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D012086:Reoperation