title: Histopathologic analysis of successful endothelial keratoplasty following multiple failed keratoplasties.
abstract: A 68-year-old woman with bilateral keratoconus presented with persistent visual acuity deficits following cataract extraction with a neodymium:YAG capsulotomy in the right eye 2 years earlier. Penetrating keratoplasty (PKP) had been performed for keratoconus in the right eye without complications until steroid drops were discontinued after 10 years because of persistent elevated intraocular pressure. The right eye experienced immunologic rejection and failure of 3 PKPs, 1 Descemet-stripping endothelial keratoplasty (DSEK), and a trabeculectomy with an eventual anatomically successful DSEK before the patient died at 95 years of age. The left eye improved following a single PKP. Postmortem histopathologic analysis of the cornea showed an anatomically successful DSEK graft with intact donor Descemet membrane and viable graft endothelial cells. To our knowledge, this is the first histopathologic analysis of an anatomically successful DSEK after multiple failed PKPs and trabeculectomy. The course in this case supports early consideration of lamellar keratoplasty, especially in patients with ocular comorbidities.
  
  
  BACKGROUND
  No author has a financial or proprietary interest in any material or method mentioned.
authors.affiliation: From Rush University Medical Center (Epstein), Chicago, Illinois; John A. Moran Eye Center (Mamalis), University of Utah, Salt Lake City, Utah; Price Vision Group (F.W. Price) and the Cornea Research Foundation of America (M.O. Price), Indianapolis, Indiana, USA.
authors.forename: Rachel H
authors.initials: RH
authors.lastname: Epstein
authors.affiliation: From Rush University Medical Center (Epstein), Chicago, Illinois; John A. Moran Eye Center (Mamalis), University of Utah, Salt Lake City, Utah; Price Vision Group (F.W. Price) and the Cornea Research Foundation of America (M.O. Price), Indianapolis, Indiana, USA. Electronic address: nick.mamalis@hsc.utah.edu.
authors.forename: Nick
authors.initials: N
authors.lastname: Mamalis
authors.affiliation: From Rush University Medical Center (Epstein), Chicago, Illinois; John A. Moran Eye Center (Mamalis), University of Utah, Salt Lake City, Utah; Price Vision Group (F.W. Price) and the Cornea Research Foundation of America (M.O. Price), Indianapolis, Indiana, USA.
authors.forename: Francis W
authors.initials: FW
authors.lastname: Price
authors.affiliation: From Rush University Medical Center (Epstein), Chicago, Illinois; John A. Moran Eye Center (Mamalis), University of Utah, Salt Lake City, Utah; Price Vision Group (F.W. Price) and the Cornea Research Foundation of America (M.O. Price), Indianapolis, Indiana, USA.
authors.forename: Marianne O
authors.initials: MO
authors.lastname: Price
mesh_terms: D000368:Aged; D003315:Cornea / Q000473:pathology*; D057111:Descemet Stripping Endothelial Keratoplasty; D005260:Female; D020327:Glaucoma Drainage Implants; D006801:Humans; D007640:Keratoconus / Q000473:pathology* / Q000601:surgery*; D015948:Keratoplasty, Penetrating; D009798:Ocular Hypertension / Q000601:surgery; D012086:Reoperation; D014130:Trabeculectomy; D017211:Treatment Failure; D014792:Visual Acuity / Q000502:physiology