title: Histopathological findings of failed grafts following Descemet's stripping automated endothelial keratoplasty (DSAEK).
abstract: OBJECTIVE
  To study the histopathological findings of the early cases of failed DSAEK grafts and to analyze the causes of graft failure.
  
  
  METHODS
  Retrospective study of 13 failed DSAEK grafts (four grafts submitted alone with no host cornea) of 12 patients. The histopathologic features are correlated with the clinical and operative findings.
  
  
  RESULTS
  Significant attenuation of the endothelial cells found in 10/13 cases (77%), retained recipient Descemet's membrane in 7/13 (54%), variability of graft thickness in 5/13 (38%) and two of these had stromal irregularity. Retrocorneal fibrous membrane along the donor's Descemet's membrane was found in 4/13 (31%) resulting in endothelial detachment in one case. Eight of the nine host cornea-graft specimens were found to have: total graft-cornea detachment (in one), subtotal in four and partial (⩽50% of graft length) in three. The detached flaps showed infection at the interface of the graft-host cornea in two, epithelial ingrowth and fibrous proliferation along the anterior stromal surface of the graft (one case each). An additional histopathological finding was secondary amyloid deposition within the host stroma (in one).
  
  
  CONCLUSIONS
  Irregular or thick graft, graft-host interface fibrous/epithelial ingrowth, and infection all predispose to DSAEK failures related to graft detachment. Endothelial cells attenuation and retrocorneal fibrous membrane are major causes for primary graft failure.
authors: Pathology and Laboratory Medicine Department, King Khaled Eye Specialist Hospital, Riyadh 11462, Saudi Arabia.
authors: Hind
authors: H
authors: Alkatan
authors: Ali
authors: A
authors: Al-Rajhi
authors: Ali
authors: A
authors: Al-Shehri
authors: Ali
authors: A
authors: Khairi
keywords: Corneal graft failure; Descemet’s stripping; Endothelial keratoplasty
references: Ophthalmology. 2007 Feb;114(2):221-6
references: 17156845
references: Ophthalmology. 2009 Apr;116(4):609-14
references: 18962919
references: Cornea. 1998 Nov;17(6):618-26
references: 9820943
references: Ophthalmology. 2008 Jul;115(7):1179-86
references: 18061268
references: Cornea. 2008 Jul;27(6):722-6
references: 18580267
references: J Refract Surg. 2005 Jul-Aug;21(4):339-45
references: 16128330
references: Cornea. 2009 Jun;28(5):530-5
references: 19421044
references: Can J Ophthalmol. 2009 Aug;44(4):401-5
references: 19606160
references: Ophthalmology. 2009 Apr;116(4):603-8
references: 19201481
references: J Cataract Refract Surg. 2006 Mar;32(3):411-8
references: 16631048
references: Cornea. 2006 Sep;25(8):926-32
references: 17102669
references: Open Ophthalmol J. 2009 Jan 09;3:1-2
references: 19554220
references: Ophthalmology. 2008 Sep;115(9):1517-24
references: 18378315
references: Cornea. 2006 Sep;25(8):943-7
references: 17102672
references: Cornea. 2007 Oct;26(9):1039-42
references: 17893530
references: Cornea. 2006 Sep;25(8):886-9
references: 17102661
references: Cornea. 2007 Apr;26(3):279-83
references: 17413953