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H. Eguchi, K. Senba, T. Miyamoto, M. Matsubara; Relationship Between Clinical Course of DSAEK and Pathological Findings of Removed Endothelial Graft. Invest. Ophthalmol. Vis. Sci. 2010;51(13):778.
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To evaluate the relationship between postoperative clinical course of descemet’s stripping automated endothelial keratoplasty (DSAEK) and the pathological findings of removed endothelial graft.Patients and
Three cases that underwent previous DSAEK and second surgery were recruited in this study. All cases had endothelial graft removal. Case 1 had a previous penetrating keratoplasty (PK) twenty years ago. He underwent a DSAEK for graft failure following long lived corneal graft. Although endothelial graft was thin and clear at 11 months postoperatively, PK was performed for the graft dislocation despite the 2 corrections. Case 2 had a previous PK 10 years ago and underwent DSAEK for graft failure following long lived corneal graft. A correction with gas tamponade was performed a day postoperatively for graft detachment, and PK was performed for graft failure 2 years postoperatively without episode of high intraocular pressure and rejection. Case 3 had previous DSAEKs twice for bullous keratopathy after lensectomy and 2 vitrectomies for trauma. Stromal edema and opacity suggestive of rejection was occurred after steroid tapering a month postoperatively. All endothelial grafts were 10% formalin fixed just after removal, and the microsection were prepared for hematoxllin-eosin staining and TdT-mediated dUTP-biotin nick end labeling (TUNEL) assay a day after removal.
In case 1, large number of keratocytes and endothelial cells were found and no inflammatory cell was existed in the graft. In case 2, although keratocytes were found, no endothelial cell was existed. In case 3, few keratocyte was found and no endothelial cell was existed. Some inflammatory cells in the lower layer of stroma and fibrin like structure at descemet’s membrane were found. Although no TUNEL-positive cell was found in case 1, some TUNEL-positive keratocytes were found in the lower stroma in case 2 and 3.
The clinical courses of three cases were associated with their pathological findings of removed endothelial grafts. Keratocyte apoptosis in the lower layer of stroma may be associated with endothelial graft failure.
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