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