Clinical and histopathologic features of failed descemet stripping automated endothelial keratoplasty grafts.
OBJECTIVE
To study the histopathologic features of Descemet stripping automated endothelial keratoplasty (DSAEK) grafts removed after graft failure and to correlate with relevant clinical features.


METHODS
Retrospective study of 8 cases in 7 patients who experienced DSAEK graft failure during the surgeons' learning phase. Perioperative clinical findings were correlated with pathologic findings of the explanted graft specimens. Imaging software was used to measure the central and peripheral thickness of each graft.


RESULTS
Graft failure occurred in association with graft detachment or excessive surgical manipulation. In 4 cases, the donor tissue detached, including 2 cases with routes for bubble escape. In 3 cases, the graft remained attached but failed to clear. The mean preoperative DSAEK button thickness was 205 +/- 61.8 microm. Average death to preservation time was 8 hours 47 minutes, and average preservation to surgery time was 2 days 22 hours. By light microscopy, explanted donor tissue showed varying degrees of keratocyte degeneration and marked endothelial cell loss. Two specimens with bubble escape had less endothelial loss, and 1 specimen showed epithelial ingrowth at the interface. Repeat keratoplasty (5 DSAEK, 2 penetrating keratoplasty) was successful in 6 of 7 cases.


CONCLUSIONS
This series correlates factors that may play a role in DSAEK failure with histopathologic features of explanted DSAEK lenticules. Marked endothelial loss was common in cases with surgical trauma but was less in cases with bubble escape. One specimen showed an epithelial membrane on the stromal interface. Outcomes of repeat DSAEK in these patients seem promising.
Department of Ophthalmology, University of Illinois at Chicago, Chicago, IL, USA.
Janet A
JA
Lee
Ali R
AR
Djalilian
Kamran M
KM
Riaz
Joel
J
Sugar
Elmer Y
EY
Tu
Hormuz
H
Wadia
Deepak P
DP
Edward
D000328:Adult; D000368:Aged; D000388:Air; D002452:Cell Count; D003316:Corneal Diseases / Q000601:surgery*; D016039:Corneal Transplantation / Q000009:adverse effects / Q000379:methods*; D003886:Descemet Membrane / Q000601:surgery*; D004728:Endothelium, Corneal / Q000473:pathology / Q000637:transplantation*; D005260:Female; D006801:Humans; D008297:Male; D008863:Microspheres; D008875:Middle Aged; D012086:Reoperation; D012189:Retrospective Studies; D013314:Stress, Mechanical; D017211:Treatment Failure