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M. L. Hsiao, P. Prasher, R. N. Hogan, J. P. McCulley, R. W. Bowman, V. V. Mootha; Histopathology of Descemet's Stripping Endothelial Keratoplasty Graft Failure. Invest. Ophthalmol. Vis. Sci. 2008;49(13):2323.
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To report the histopathological findings of failed endothelial grafts in patients who underwent Descemet's Stripping Endothelial Keratoplasty (DSEK) to treat clinically significant endothelial disease.
Retrospective case series. Patients 1 and 2 underwent DSEK for corneal edema secondary to Fuchs' dystrophy. Both patients had graft dislocations that were treated with injection of an air bubble in the anterior chamber in the early post-op period. Patient 1 underwent penetrating keratoplasty 15 months after the initial procedure for persistent edema and anterior stromal scarring limiting vision. Patient 2 underwent repeat DSEK 17 months after the initial procedure for graft failure secondary to immunological rejection.
Histopathologic evaluation of the corneal buttons showed thickened and edematous corneal tissues with atrophic endothelium in both cases. A multilayered epithelial ingrowth was seen on the graft button on the stromal side in case 1. The host cornea showed diffuse edema and stromal scarring; however no conspicuous scarring was evident at the site of the interface. The graft showed diffuse stromal scarring and thickening in case 2.
The histopathology in these two patients suggests epithelial ingrowth and endothelial decompensation secondary to immunological rejection as possible etiologies of graft failure after DSEK.
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