Histologically proven epithelial ingrowth in failed Descemet stripping automated endothelial keratoplasty (DSAEK) managed by repeat DSAEK

Figures & data

Figure 1 (A) Photograph after Descemet stripping automated endothelial keratoplasty showing a white opacity (arrow) at the interface at the 12 o’clock position away from the temporal host corneal incision site. (B) Magnified view of the area of white opacity (arrow) at the interface. (C) Slit-lamp image showing epithelial ingrowth (arrow) between the graft and the host cornea. (D) Postoperative photograph after repeat Descemet stripping automated endothelial keratoplasty showing a clear cornea.

Figure 2 (A) Low power shot of the removed donor button to show full thickness of specimen at one side. Here there is epithelium (e) on part of the anterior face of the specimen. Also, Descemet’s membrane (d), is present on the back of the specimen, as well as, focally, at the front on this edge (hematoxylin and eosin, original magnification ×4). (B) Hematoxylin and eosin, original magnification ×40 to show epithelium along the anterior aspect of the specimen (arrow). Note that there is no Descemet’s membrane. (C) Hematoxylin and eosin, original magnification ×10 of the removed donor button shows view of area beneath epithelium. Arrow shows epithelium on the anterior face of the specimen. Posteriorly there is no endothelium. (D) High power of the back of the removed donor button specimen (hematoxylin and eosin, original magnification ×40). Shows graft Descemet membrane with some thickening and incipient guttae (arrow). There is no endothelium, suggestive of graft failure. Note the normal relationship of Descemet membrane to stroma.

Table 1 Literature review of epithelial migration into anterior chamber after DSAEK

Study	Number of eye(s)	Description	Diagnosis	Graft failure	Treatment
Suh et al^Citation9	1	Epithelial growth at the interface	Clinically anterior segment optical coherence tomography	No	Nil
Culbertson^Citation10	1	Epithelial downgrowth	Confocal microscopy	No	PK
Koenig and Covert^Citation11	1	Epithelial ingrowth-interface	Histology	Yes	Repeat DSAEK
Walker et al^Citation12	1	Epithelial downgrowth-at the interface	Confocal microscopy, histology	No	PK
Prasher et al^Citation13	2	Case 1-epithelial downgrowth-interface Case 2-epithelial downgrowth-not at the interface	Histology	Yes	Case 1 had PK Case 2 had DSAEK
Phillips et al^Citation14	1	Conjunctival epithelial downgrowth-over donor endothelium	Histology	Yes	Repeat DSAEK
Gorovoy and Ratanasit^Citation15	1	Epithelial downgrowth-not at the interface	Histology	Yes	Repeat DSAEK
Saelens et al^Citation16	1	Epithelial ingrowth in the flap-graft interface	Histology	Yes	Posterior mushroom keratoplasty
Lee et al^Citation17	1	Epithelial ingrowth at the interface	Histology	Yes	Repeat DSAEK
Suh et al^Citation18	5	Epithelial ingrowth interface-1	AS-OCT-1, spectral domain	None documented	Observation in 4 cases
		Interface + retrocorneal-4	Ultrahigh resolution OCT-3, histology-1		Block excision and corneoscleral graft in 1 case
Bansal et al^Citation19	1	Epithelial ingrowth after stromal puncture	Clinical	No	Nil

Abbreviations: DSAEK, Descemet stripping automated endothelial keratoplasty; PK, Penetrating Keratoplasty; AS-OCT, Anterior segment optical coherence tomography; OCT, optical coherence tomography.

SuhLHYooSHDeobhaktaAComplications of Descemet’s stripping with automated endothelial keratoplasty: survey of 118 eyes at one instituteOphthalmology20081151517152418378315

 PubMed Web of Science ®Google Scholar

CulbertsonWWDescemet stripping endothelial keratoplastyInt Ophthalmol Clin200646315516816929232

 PubMedGoogle Scholar

KoenigSBCovertDJEpithelial ingrowth after Descemet stripping automated endothelial keratoplastyCornea20082772772918580268

 PubMed Web of Science ®Google Scholar

WalkerBMHindmanHBEbrahimiKBEpithelial downgrowth following Descemet’s stripping automated endothelial keratoplasty [letter]Arch Ophthalmol200812627828018268229

 PubMedGoogle Scholar

PrasherPMuftuogluOHsiaoMLEpithelial downgrowth after Descemet-stripping automated endothelial keratoplastyCornea200928670871119512895

 PubMedGoogle Scholar

PhillipsPMTerryMAKaufmanSCEpithelial downgrowth after Descemet-stripping automated endothelial keratoplastyJ Cataract Refract Surg20093519319619101445

 PubMed Web of Science ®Google Scholar

GorovoyMSRatanasitAEpithelial downgrowth after Descemet stripping automated endothelial keratoplastyCornea2010291192119420628298

 PubMedGoogle Scholar

SaelensIEYBartelsMCVan RijGIntroduction of epithelial cells in the flap-graft interface during Descemet stripping automated endothelial keratoplastyArch Ophthalmol2009127793693719597119

 PubMedGoogle Scholar

LeeJADjalilianARRiazKMClinical and histopathologic features of failed Descemet stripping automated endothelial keratoplasty graftsCornea200928553053519421044

 PubMedGoogle Scholar

SuhLHShoushaMAVenturaRUEpithelial ingrowth after Descemet stripping automated endothelial keratoplasty: description of cases and assessment with anterior segment optical coherence tomographyCornea20113052853421107249

 PubMed Web of Science ®Google Scholar

BansalRRamasubramanianADasPIntracorneal epithelial ingrowth after Descemet stripping endothelial keratoplasty and stromal punctureCornea200928333433719387237

 PubMedGoogle Scholar