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E. E. Kim, J. C. Song, S. Yiu, F. Memarzadeh, N. A. Rao; The Histologic Analysis of Descemet's Membrane and Its Clinical Relevance in DSAEK. Invest. Ophthalmol. Vis. Sci. 2009;50(13):636.
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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.
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.
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.
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.
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