title: Clinicopathologic findings in failed descemet stripping automated endothelial keratoplasty.
abstract: OBJECTIVE
  To evaluate the clinical features of and histologic findings from failed Descemet stripping automated endothelial keratoplasty (DSAEK).
  
  
  METHODS
  This retrospective observational case series evaluated 47 consecutive corneal specimens from 42 patients who underwent either penetrating keratoplasty or repeated DSAEK for failed DSAEK. Clinical information was obtained for the cases. Sections of the specimens were examined using light microscopy. Immunohistochemical staining was performed for cytokeratins AE1/AE3 and for the myogenic marker smooth-muscle actin when indicated. Transmission electron microscopic examination was performed in some cases.
  
  
  RESULTS
  Graft survival ranged from 0.5 to 34 months. Histologic examination showed that 94% of the specimens (44 of 47) had endothelial cell loss. Residual host Descemet membrane (19%; 9 of 47), fibrocellular tissue (19%; 9 of 47), epithelial implantation (15%; 7 of 47), and fungal infection (4%; 2 of 47) were also identified. Immunohistochemical stains were positive for AE1/AE3 in the epithelial implantations and for smooth-muscle actin in cells in the fibrocellular proliferations.
  
  
  CONCLUSIONS
  The principal cause of failed DSAEK is endothelial cell loss. Residual host Descemet membrane, fibrocellular tissue at the edge of the lenticule, and epithelial implantation are common histologic findings. Fungal infection may occur in the setting of DSAEK.
authors.affiliation: Department of Ophthalmology, Emory University School of Medicine, Atlanta, Georgia, USA.
authors.forename: Qing
authors.initials: Q
authors.lastname: Zhang
authors.forename: J Bradley
authors.initials: JB
authors.lastname: Randleman
authors.forename: R Doyle
authors.initials: RD
authors.lastname: Stulting
authors.forename: W Barry
authors.initials: WB
authors.lastname: Lee
authors.forename: Donald U
authors.initials: DU
authors.lastname: Stone
authors.forename: Alan M
authors.initials: AM
authors.lastname: Kozarsky
authors.forename: Hans E
authors.initials: HE
authors.lastname: Grossniklaus
mesh_terms: D000199:Actins / Q000378:metabolism; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003317:Corneal Dystrophies, Hereditary / Q000601:surgery*; D055954:Corneal Endothelial Cell Loss / Q000209:etiology / Q000378:metabolism / Q000473:pathology*; D003886:Descemet Membrane / Q000378:metabolism / Q000473:pathology*; D057111:Descemet Stripping Endothelial Keratoplasty / Q000009:adverse effects*; D015821:Eye Infections, Fungal / Q000209:etiology / Q000378:metabolism / Q000473:pathology*; D005260:Female; D006084:Graft Rejection / Q000209:etiology / Q000378:metabolism / Q000473:pathology*; D006085:Graft Survival; D006801:Humans; D007124:Immunoenzyme Techniques; D007633:Keratins / Q000378:metabolism; D015948:Keratoplasty, Penetrating; D008297:Male; D008875:Middle Aged; D012086:Reoperation; D012189:Retrospective Studies; D017211:Treatment Failure
chemical_list: C541116:ACTA2 protein, human; D000199:Actins; D007633:Keratins