Purchase this article with an account.
Nathan Pirakitikulr, Jaime D Martinez, Armando L Garcia, Raquel Goldhardt, Sander Dubovy, Guillermo Amescua, Anat Galor; Myofibroblastic membranes after corneal surgery: a clinical histopathologic correlation study. Invest. Ophthalmol. Vis. Sci. 2019;60(9):6297.
Download citation file:
© ARVO (1962-2015); The Authors (2016-present)
To report five cases of Descemet Stripping Automated Endothelial Keratoplasty (DSAEK) failure that occurred in the setting of progressive, contractile fibromembranous proliferation involving the cornea, lens and iris.
Retrospective chart review of five cases at the University of Miami Veteran’s Hospital and Bascom Palmer Eye institute and immunohistochemical analysis of the fibrous tissue invading the cornea.
We identified 5 cases of DSAEK that failed in the setting of progressive fibromembranous proliferation involving the cornea, lens and iris. The median patient age at time of DSAEK surgery was 66 years (range: 54-81); 3 patients were male and 2 female; 3 patients were black and 2 white. At the time of DSAEK, all 5 eyes were pseudophakic (posterior chamber lens 3/5, anterior chamber lens 2/5), all 5 had glaucoma tubes placed for either primary open angle glaucoma (3/5), neovascular glaucoma (1/5) or chronic angle closure glaucoma (1/5), 2 had a history of a partial or total vitrectomy, and 1 a history of anterior and intermediate uveitis. In 4 eyes, contractile fibrous membranes were noted on exam prior to graft failure. The median time from DSAEK to when the membranes were first noted was 5 months (range: 0-6). They eventually resulted in the iris coming into contact with the DSAEK graft and ultimate graft failure on average of 6.6 months after surgery (range: 1-12). All patients subsequently underwent a full thickness penetrating keratoplasty (PKP) with removal of membranes and adherent iris material, with resultant clear corneas and no recurrent membranes noted on median 3 months after surgery, (range 2 weeks-1 year). Histopathology identified a pigmented fibrocellular tissue adherent to the cornea and iris. Further examination disclosed the tissue was SMA positive and cytokeratin negative indicating the presence of smooth muscle and absence of epithelial cells.
Myofibroblastic membranes are a rare but important cause of rapid DSAEK failure characterized by contractile membranes between the cornea and iris. The present series describes 5 patients in whom this entity was identified and successfully managed. Further investigation is needed to identify the source of the membranes.
This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.
This PDF is available to Subscribers Only