Abstract
Purpose: :
DSAEK is an endothelial transplantation procedure in which the diseased endothelium is replaced along with the Descemet’s membrane. A retrospective analysis was done to determine the accuracy of Descemet’s stripping in DSAEK and its effect on clinical outcome.
Methods: :
One hundred and five consecutive samples of Descemet’s membrane from 99 patients with corneal edema mostly due to Fuch’s dystrophy, bullous keratopathy, or a failed penetrating keratoplasty were examined under a light microscope with H&E and PAS staining. Corneal transplantation failure was defined as corneal edema that did not resolve with maximum medical therapy or as a dislocation that could not be repositioned successfully. Data collected included histologic analysis of the stripped Descemet’s membrane, pre-operative and post-operative vision, post-operative or intraoperative complications, whether or not graft failure occurred, and histologic analysis of the second Descemet’s stripping in graft failure cases.
Results: :
The Descemet’s membranes fell into one of two categories: clean and unclean (i.e. the presence of residual stroma or a retrocorneal membrane). Seventy-six samples were histologically clean and 29 samples had either residual stroma (13) or a retrocorneal membrane (16). A total of 23 (21.9%) graft failures occurred from the 105 DSAEK surgeries performed. Seventeen out of the 23 patients (73.9%) who had DSAEK failures had a histologically-unclean stripping of the Descemet’s membrane. Thirteen patients of the 23 failed grafts (56.5%) had a retrocorneal membrane and four of the 23 (17.4%) had residual corneal stroma. The remaining six patients who had DSAEK failure had a histologically-clean Descemet’s membrane. Three (50%) of these patients had a pre-existing anterior chamber intraocular lens (ACIOL) and two (33.3%) of these patients had intraoperative complications requiring lenticule sutures for reinforcement.Also, out of the 23 patients with DSAEK failures, seven of these patients underwent a regraft procedure. Out of these seven, six patients (85.7%) had a retrocorneal membrane on the original Descemet’s membrane specimen submitted and also had a retrocorneal membrane on the second specimen submitted for histologic analysis. The remaining patient had residual stroma seen on both the original and second specimens.
Conclusions: :
This study shows increased risk of DSAEK failure when the patient has a histologically-unclean stripping of Descemet’s membrane. Other factors that may increase the likelihood of failure include the presence of a retrocorneal membrane, an ACIOL, or the need for use of sutures for lenticule positioning.
Keywords: cornea: endothelium • transplantation • pathology: human