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T. John, G.G. Fraenkel, M.E. John; KERATOCYTE DENSITIES AND INTERFACE CHANGES IN FAILED DEEP LAMELLAR ENDOTHELIAL KERATOPLASTY (DLEK) . Invest. Ophthalmol. Vis. Sci. 2004;45(13):2903.
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© ARVO (1962-2015); The Authors (2016-present)
Purpose: Failed deep lamellar endothelial keratoplasty (DLEK) is a new and evolving corneal replacement surgery without corneal surface incision or sutures. This study evaluated the keratocyte profile and donor–host interface in failed DLEK grafts. Methods:Penetrating keratoplasty (PK) was performed on failed DLEK in 3 eyes [3 patients; 2 women, 1 man; average age, 81 yr (range, 74 – 87)]. The average time between DLEK and PK was 8 months (range, 6–12). The preoperative diagnoses were pseudophakic bullous keratopathy (n=2) and Fuchs’ dystrophy with cataract (n=1). One patient underwent DLEK combined with clear cornea phacoemulsification and foldable posterior chamber intraocular lens implant. The disk diameters for DLEK and the diameter for the PK were 8.0 mm. Corneal graft failure was established clinically with corneal edema and keratic precipitates. All corneas were processed for light and electron microscopy (scanning [SEM] and transmission [TEM]). Results: Light microscopy showed epithelial edema and the host–donor interface (HDI). SEM showed HDI and inflammatory cells on the endothelium. TEM showed prominent curvilinear arrangement of the collagen bundles and scattered electron dense materials in the HDI. The endothelium had attached lymphocytes. The keratocyte densities and profile were as follows:
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