title: Failed descemet-stripping automated endothelial keratoplasty grafts: a clinicopathologic analysis.
abstract: OBJECTIVE
  To describe the clinicopathologic findings in failed Descemet-stripping automated endothelial keratoplasty (DSAEK) grafts.
  
  
  METHODS
  Retrospective, interventional case series.
  
  
  METHODS
  
  
  
  METHODS
  New York Eye and Ear Infirmary.
  
  
  METHODS
  Twenty-one patients with 22 failed DSAEK grafts treated between March 1, 2006 and February 1, 2008.
  
  
  METHODS
  Repeat DSAEK or penetrating keratoplasty were performed in the eyes with failed grafts. All failed grafts were examined histopathologically.
  
  
  METHODS
  Histopathologic parameters studied in failed DSAEK grafts included endothelial cell count, interface characteristics, retrocorneal membrane formation, inflammation, and immunoreactivity for herpes simplex virus type 1 (HSV-1) antigen.
  
  
  RESULTS
  DSAEK failure was strongly associated with postoperative lenticle dislocation. Graft failure was primary in 19 DSAEKs and secondary to rejection, eccentric trephination with epithelial ingrowth, or bacterial infection in the remaining 3. All failed grafts demonstrated endothelial hypocellularity and stromal edema. Additional findings included stromal inflammation (68%), interface fibrosis (50%), retrocorneal membrane (36%), unplanned retention of Descemet membrane (14%), immunoreactivity for HSV-1 (14%), paucicellular stroma (14%), and uneven trephination with epithelial ingrowth (5%).
  
  
  CONCLUSIONS
  Most DSAEK failures are secondary to endothelial cell loss. Other contributing factors include interface fibrosis, retrocorneal membrane formation, retained host Descemet membrane, uneven trephination, epithelial ingrowth, graft rejection, and infection.
authors.affiliation: Department of Ophthalmology, The New York Eye and Ear Infirmary, New York, NY 10003, USA.
authors.forename: Julia
authors.initials: J
authors.lastname: Shulman
authors.forename: Mark
authors.initials: M
authors.lastname: Kropinak
authors.forename: David C
authors.initials: DC
authors.lastname: Ritterband
authors.forename: Henry D
authors.initials: HD
authors.lastname: Perry
authors.forename: John A
authors.initials: JA
authors.lastname: Seedor
authors.forename: Steven A
authors.initials: SA
authors.lastname: McCormick
authors.forename: Tatyana
authors.initials: T
authors.lastname: Milman
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002452:Cell Count; D003316:Corneal Diseases / Q000473:pathology*; D016039:Corneal Transplantation; D003886:Descemet Membrane / Q000601:surgery*; D004728:Endothelium, Corneal / Q000473:pathology / Q000637:transplantation*; D005260:Female; D005642:Fuchs' Endothelial Dystrophy / Q000601:surgery; D006801:Humans; D015948:Keratoplasty, Penetrating; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D012086:Reoperation; D012189:Retrospective Studies; D012307:Risk Factors; D014019:Tissue Donors; D017211:Treatment Failure