Histopathologic Examination of Failed Grafts in Descemet's Stripping with Automated Endothelial Keratoplasty

Textural Interface Opacity After Descemet Stripping Automated Endothelial Keratoplasty

“…3,5,17,18,19 Other possible interface abnormalities, such as blood, inflammatory or epithelial cells, metallic particles, calcareous degeneration, or retained Descemet membrane, have been reported. 11,17,[20][21][22][23] Although there have been a few small case series reporting an interface haze or opacity, this is the largest case series to describe the condition with its potential impact on visual outcomes. 18,19,[24][25][26][27] In this case series, there were no signs of inflammation, rejection, edema, or infiltrate in association with the interface opacity.…”

Untitled

“…Nevertheless, the retrocorneal fibrocellular tissue also was found in failed DSEK/Descemet's membrane stripping (automated) endothelial keratoplasty (DSAEK) cases and was supposed as a potential cause of dislocation. 16,[24][25] In some researchers' opinions, the retrocorneal fibrocellular tissue is presumably secondary to debris dragged in during insertion of the folded graft, which may induce the cellular proliferation that forms at the interface. 24 This was inconsistent with our study as no graft insertion occurred in the control group.…”

“…16,[24][25] In some researchers' opinions, the retrocorneal fibrocellular tissue is presumably secondary to debris dragged in during insertion of the folded graft, which may induce the cellular proliferation that forms at the interface. 24 This was inconsistent with our study as no graft insertion occurred in the control group. Wilson and associates 29 demonstrated that the introduction of ectopic epithelial tissue into corneal stroma showed subsequent proliferation of stromal keratocytes, and the appearance of myofibroblasts, which led to stromal remodeling and scarring.…”

“…Thus, the retrocorneal fibrocellular tissue found in the interface may indicate tiny incomplete adherence between the graft and the host, which cannot be explored under slit lamp examination or OCT (ie, the membrane in the interface may suggest poor adherence if detected), and will not influence the clearance of the entire cornea. 24 As the membrane began from the broken end of the DM, we considered that it may be secreted from the peripheral endothelium. Actually, observations have suggested that the corneal endothelial cells can transform to fibroblasts.…”

“…The literature has addressed the clinicopathologic findings of failed DSEK cases with the attempt to discover the causes of graft detachment as well as graft failure. [13][14][15][16][17][18][19][20][21][22][23][24][25][26] In 2 case reports of failed grafts, the residual Descemet's membrane (DM) in the interface was thought to be the cause of graft failure. 19,21 However, another case report asserts the opposite.…”