A clinicopathologic series of primary graft failure after Descemet's stripping and automated endothelial keratoplasty.

Abstract

To characterize the clinical and histologic features of primary graft failure after Descemet's stripping and automated endothelial keratoplasty (DSAEK). Retrospective observational case series. Sixteen cases of DSAEK graft failure from 15 patients, all with detailed histologic examination of failed graft tissue. Hematoxylin-eosin, periodic acid-Schiff staining, and light microscopy were used to examine the failed DSAEK graft tissue from all patients. Examination of specimens for corneal endothelial cell viability and host-donor interface characteristics. Clinical history revealed that 88% (14/16) of studied DSAEK grafts detached before failure, and pathologic examination found that 75% (12/16) of failed grafts had atrophic corneal endothelium. Examples of residual host Descemet's membrane in the graft site and improper donor trephination were also identified. Marked loss of the corneal endothelium is the prominent feature of primary DSAEK graft failure. Examples of surgical features, such as incomplete Descemet's stripping and residual full-thickness cornea with a DSAEK graft, are shown.