April 2009
Volume 50, Issue 13
Free
ARVO Annual Meeting Abstract  |   April 2009
The Histologic Analysis of Descemet's Membrane and Its Clinical Relevance in DSAEK
Author Affiliations & Notes
  • E. E. Kim
    Ophthalmology, Doheny Eye Institute, Los Angeles, California
  • J. C. Song
    Ophthalmology, Doheny Eye Institute, Los Angeles, California
  • S. Yiu
    Ophthalmology, Doheny Eye Institute, Los Angeles, California
  • F. Memarzadeh
    Ophthalmology, Doheny Eye Institute, Los Angeles, California
  • N. A. Rao
    Ophthalmology, Doheny Eye Institute, Los Angeles, California
  • Footnotes
    Commercial Relationships  E.E. Kim, None; J.C. Song, None; S. Yiu, None; F. Memarzadeh, None; N.A. Rao, None.
  • Footnotes
    Support  None.
Investigative Ophthalmology & Visual Science April 2009, Vol.50, 636. doi:https://doi.org/
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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. doi: https://doi.org/.

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      © ARVO (1962-2015); The Authors (2016-present)

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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 
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