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Andrea Naranjo, Nathan Pirakitikulr, Jaime D. Martinez, Guillermo Amescua, Anat Galor, Sander R Dubovy; Characterization of fibrocellular retrocorneal membranes associated with lamellar corneal grafts failure. Invest. Ophthalmol. Vis. Sci. 2020;61(7):3569.
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© ARVO (1962-2015); The Authors (2016-present)
To characterize fibrocellular retrocorneal membranes associated with Descemet Stripping Automated Endothelial Keratoplasty (DSAEK) failure.
Under approval of the institutional review board, the database of the Florida Lions Ocular Pathology Laboratory at the Bascom Palmer Eye Institute was searched for surgical specimens with a diagnosis of failed DSAEK grafts and retrocorneal membranes. The specimens and medical records of the patients diagnosed with clinically significant retrocorneal membranes associated with DSAEK failure were reviewed for demographics, clinical presentation, comorbidities and surgeries performed. A subset of these were further characterized using immunohistochemistry for smooth muscle actin (SMA) and keratin as well as immunofluorescence for Rho-A and ROCK1.
A total of 72 cases were identified from January 2016 – December 2019 with a history of failed DSAEK and a retrocorneal membrane. Seven of these patients had a clinically significant retrocorneal proliferation at the time of graft failure. Four of them were males and three female. The average age at the time of repeat surgery was 71 years old (range: 55-85). Six patients were pseudophakic and all seven patients had glaucoma drainage implants placed. Within six months of surgery a thin retrocorneal fibrous membrane was observed, eventually leading to graft failure. Five patients underwent penetrating keratoplasty and two underwent repeat DSAEK. On histopathologic evaluation, a pigmented fibrocellular tissue was identified along the posterior margin of the corneas and DSAEK buttons in all cases. A subset of 5 cases was further characterized and immunohistochemical studies demonstrated all membranes to be negative for keratin and positive for SMA, ROCK1 and Rho-A.
Fibrocellular retrocorneal membrane proliferation may be associated with DSAEK failure in patients with previous glaucoma implant surgery. Our results demonstrate myofibroblastic differentiation and a lack of epithelial differentiation. The presence of ROCK1 and Rho-A positivity may allow for future targeted pharmacotherapy.
This is a 2020 ARVO Annual Meeting abstract.
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