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Author Notes:

Correspondence: Hans E. Grossniklaus, MD, MBA, L.F. Montgomery Ophthalmic Pathology Laboratory, BT428 Emory Eye Center, 1365 Clifton Rd, Atlanta, GA 30322. Email: ophtheg@emory.edu.

Financial Disclosure: None reported.


Research Funding:

Supported in part by grant NEI P30EY06360 from the National Institutes of Health and by an unrestricted departmental grant from Research to Prevent Blindness Inc.

Clinicopathologic Findings in Failed Descemet Stripping Automated Endothelial Keratoplasty


Journal Title:

Archives of ophthalmology (Chicago, Ill. : 1929)


Volume 128, Number 8


, Pages 973-980

Type of Work:

Article | Post-print: After Peer Review


Objective To evaluate the clinical features of and histologic findings from failed Descemet stripping automated endothelial keratoplasty (DSAEK). Methods This retrospective observational case series evaluated 47 consecutive corneal specimens from 42 patients who underwent either penetrating keratoplasty or repeated DSAEK for failed DSAEK. Clinical information was obtained for the cases. Sections of the specimens were examined using light microscopy. Immunohistochemical staining was performed for cytokeratins AE1/AE3 and for the myogenic marker smooth-muscle actin when indicated. Transmission electron microscopic examination was performed in some cases. Results Graft survival ranged from 0.5 to 34 months. Histologic examination showed that 94% of the specimens (44 of 47) had endothelial cell loss. Residual host Descemet membrane (19%; 9 of 47), fibrocellular tissue (19%; 9 of 47), epithelial implantation (15%; 7 of 47), and fungal infection (4%; 2 of 47) were also identified. Immunohistochemical stains were positive for AE1/AE3 in the epithelial implantations and for smooth-muscle actin in cells in the fibrocellular proliferations. Conclusions The principal cause of failed DSAEK is endothelial cell loss. Residual host Descemet membrane, fibrocellular tissue at the edge of the lenticule, and epithelial implantation are common histologic findings. Fungal infection may occur in the setting of DSAEK.

Copyright information:

© 2010, American Medical Association

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