May 2008
Volume 49, Issue 13
Free
ARVO Annual Meeting Abstract  |   May 2008
Pathologic Analysis of Graft Failure in Descemet's Stripping Endothelial Keratoplasty
Author Affiliations & Notes
  • D. Tarnawska
    Ophthalmology, District Railway Hospital, Katowice, Poland
  • E. Wylegala
    Ophthalmology, District Railway Hospital, Katowice, Poland
  • M. Snietura
    Tumor Pathology, Maria Sklodowska-Curie Memorial Cancer Center and Oncology Institute, Gliwice Branch, Gliwice, Poland
  • D. Lange
    Tumor Pathology, Maria Sklodowska-Curie Memorial Cancer Center and Oncology Institute, Gliwice Branch, Gliwice, Poland
  • Footnotes
    Commercial Relationships  D. Tarnawska, None; E. Wylegala, None; M. Snietura, None; D. Lange, None.
  • Footnotes
    Support  None.
Investigative Ophthalmology & Visual Science May 2008, Vol.49, 1946. doi:https://doi.org/
  • Views
  • Share
  • Tools
    • Alerts
      ×
      This feature is available to authenticated users only.
      Sign In or Create an Account ×
    • Get Citation

      D. Tarnawska, E. Wylegala, M. Snietura, D. Lange; Pathologic Analysis of Graft Failure in Descemet's Stripping Endothelial Keratoplasty. Invest. Ophthalmol. Vis. Sci. 2008;49(13):1946. doi: https://doi.org/.

      Download citation file:


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

      ×
  • Supplements
Abstract

Purpose: : To report the histopathologic features of two failed grafts after Descemet’s stripping with endothelial keratoplasty (DSEK).

Methods: : From the total of 97 DLEK and DSEK performed in our unit, two patients underwent penetrating keratoplasty (PK) for cornea decompensation after DSEK. A 60-year-old patient with Fuchs dystrophy (Case 1) and a 63-year-old patient with pseudophakic bullous keratopathy (Case 2) underwent DSEK. The second patient needed graft repositioning on the first post-DSEK day. Progressive corneal edema was observed in both patients from first postoperative days with gradual corneal thickness increase. PK was performed 4 and 8 months after DSEK, respectively. Corneal buttons were fixed in formaldehyde and embedded in parafin. For light microscopic examination the 5-µm-thick sections were stained with hematoxylin and eosin, Masson trichrom and van Gieson. For three-dimensional layout reconstruction with confocal laser microscope the specimens were stained with eosin and auramine.

Results: : In Case 1 we found improper donor disc position so that the donor endothelium was apposed to the host stroma. Nevertheless, disc was adjacent thanks to peripheral adhesion in region of graft edge devoid of Descemet’s membrane. Total corneal thickness was 970 µm. In Case 2 we observed markedly attenuated endothelium with sparse cells. The graft was well positioned with 40 to 95-µm-thick adhesion consisted of subtle, nonuniform oriented collagen fibrils. The total stromal thickness was 1200 µm, graft thickness was 300-320 µm.

Conclusions: : Although not reported so far, improper position of the donor corneal lenticule, should be taken into account as a possible cause of graft failure. This complication is more probable in thick corneas with poor intraoperative visualization in which techniques to reduce the likelihood of this complication could be insufficient.Disc repositioning in early postoperative period allows create regular graft-donor adhesion, nevertheless, causes endothelial cell loss that could also result in graft decompensation.

Keywords: cornea: clinical science • transplantation • pathology: human 
×
×

This PDF is available to Subscribers Only

Sign in or purchase a subscription to access this content. ×

You must be signed into an individual account to use this feature.

×