Abstract
Purpose :
Descemet Stripping Automated Endothelial Keratoplasty (DSAEK) is one of the most frequently performed procedures by corneal surgeons. Originally, it was the only endothelial keratoplasty (EK) performed, but since the popularization of Descemet Membrane Endothelial Keratoplasty (DMEK), DSAEK has become the EK of choice for more challenging cases. The histopathological findings of failed DSAEK grafts were initially described 14 years ago when DMEK was not widely available. The purpose of this study is to describe the histopathological findings of failed DSAEK grafts in a time frame where DMEK is also performed and to compare them with previous observations.
Methods :
A total of 23 DSAEK grafts were studied from the MUHC-McGill University Ocular Pathology & Translational Research from 2012 to 2022. A retrospective study was performed reviewing the histopathological features of the cases that underwent DSAEK or Penetrating Keratoplasty (PK) as a result of previous DSAEK graft failure. Age, sex, clinical diagnosis and histopathological findings were reviewed.
Results :
Out of the 23 patients studied, 17 were female and 6 were male, with an average age of 70.48 years (range: 27-92 years). The most predominant histopathological finding was extensive areas of fibrosis of the corneal stroma, identified in 18 cases (78%) followed by endothelial attenuation or absence, reported as endothelial decompensation, in 17 specimens (74%). Less frequently observed were instances of chronic inflammation in 4 cases (17%) and the presence of pigment-containing cells consistent with anterior synechiae, also noted in 4 cases (17%).
Conclusions :
The two most predominant histopathological findings in failed DSAEK grafts are the presence of fibrosis of the corneal stroma and endothelial decompensation, as described in previous publications. In addition, we did not find any remnants from the recipients' Descemet membrane or any epithelial ingrowth. The novel finding of the presence of pigment-containing cells attributed to anterior synechia was noted in our series. This novel observation supports the explanation for the preference of DSAEK in more complex cases involving previous ocular surgeries.
This abstract was presented at the 2024 ARVO Annual Meeting, held in Seattle, WA, May 5-9, 2024.