gms | German Medical Science

22nd International Congress of German Ophthalmic Surgeons

18. to 21.06.2009, Nürnberg

Histopathologic and Ultrastructural Findings of Failed Posterior Lamellar Corneal Grafts after Descemet-Stripping Endothelial Keratoplasty (DSEK)

Meeting Abstract

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  • Ingo Schmack - Universitäts-Augenklinik Heidelberg, Heidelberg
  • Ke Lui - Emory Eye Center, Atlanta, USA
  • Shin Kang - Emory Eye Center, Atlanta, USA
  • Grossniklaus Hans E - Emory Eye Center, Atlanta, USA

22. Internationaler Kongress der Deutschen Ophthalmochirurgen. Nürnberg, 18.-21.06.2009. Düsseldorf: German Medical Science GMS Publishing House; 2009. Doc09docPO 2.4

DOI: 10.3205/09doc051, URN: urn:nbn:de:0183-09doc0510

Published: July 9, 2009

© 2009 Schmack et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.en). You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.


Outline

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Purpose: Morphologic and ultrastructural evaluation of human posterior lamellar corneal grafts with history of Descemet-Stripping Endothelial Keratoplasty (DSEK).

Methods: Corneal full-thickness and posterior lamellar grafts (6 each) were obtained from 12 patients (mean age, 74.4 yrs; range, 66–88 yrs; male/female, 5/7; OD/OS, 6/6) following unsuccessful DSEK surgery. All specimens were formalin fixed, paraffin embedded, and evaluated by light and electron microscopic evaluation. A retrospective chart review was performed in all cases.

Results: Clinical indications for DSEK were Fuchs endothelial dystrophy (n=7) and pseudophakic bullous keratopathy (n=5). Reasons for DSEK graft failure and subsequent flap removal included advanced corneal edema, interface haze, and flap detachment. In the majority, posterior lamellar grafts demonstrated mild to severe corneal edema; only 2 specimens showed no stromal swelling. The mean central corneal thickness of the anterior corneal stroma and the posterior lamellar graft was 552.1±144.1 µm (range, 433.1±777.9 µm) and 157.5±55.0 µm (range, 72.0–264.7 µm), respectively. Ultrastructural evaluation revealed lamellar interweaving and large interlamellar spaces. The interface between the anterior corneal stroma and the posterior lamellar graft displayed epithelial ingrowth and pigment-laden cells in 3 specimens. Endothelial cell counts ranged form 0 to 12 cells per HPF.

Conclusions: DSEK advances the treatment options in patients with corneal endothelial dysfunction and low endothelial cell density (e.g., Fuchs endothelial dystrophy or bullous keratopathy). However, surgeon have to be aware of potential intra- and postoperative complications (e.g., endothelial cell loss or flap detachment), which might result in secondary graft failure.