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Pho Nguyen, Narsing A. Rao, Samuel C. Yiu; Histopathology of host Descemets in failed Descemet's Stripping Endothelial Keratoplasty. Invest. Ophthalmol. Vis. Sci. 2012;53(14):21.
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Previously, we established that a preexisting history of glaucoma or glaucoma surgeries is associated with increased risks of primary graft failure in DSAEK. Here, we investigated the correlation between histopathology findings of stripped host Descemets membrane and graft survival.
This IRB-approved retrospective study reviewed records of 120 patients undergoing DSAEK. Histopathologic findings of stripped host Descemet membranes, using hematoxylin and eosin and periodic acid-Schiff stains, were recorded. Host Descemets membranes without any additional cells or tissues besides endothelium and/or residual host stroma were classified as "clean"; the presence of additional tissues, e.g. retrocorneal membrane or uveal tissue, qualified for "unclean" classification. Subsequently, we correlated the histologic findings and graft survival.
120 pathology reports were reviewed; 5 were excluded, 105 was categorized as "clean" and 10 "unclean". 14/85 patients with "clean" host Descemets having remnant endothelium failed. 4/20 patients with "clean" host Descemets having residual corneal stroma failed. 4/10 patients with "unclean" Descemets failed. "Unclean" stripped host Descemets were associated with complicated ocular history, especially prior incisional glaucoma surgeries (OR 6.9, p = 0.01). A higher rate of graft failure (OR 3.63, p = 0.13) was observed as well in this group.
Previously, retrocorneal tissues were shown to be caused by aberrant wound regeneration in PKP rabbit model or by local inflammation and endothelial damage in immunouveitis rabbit model. This study suggests an increased risk of primary graft failure in corneas having retromembrane tissues. Further studies are indicated to elucidate the pathogenesis of graft failure and investigate management options to reduce the risks of failure.
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