Document Detail

Epithelial downgrowth after Descemet stripping automated endothelial keratoplasty.
MedLine Citation:
PMID:  20628298     Owner:  NLM     Status:  MEDLINE    
PURPOSE: To report the clinical and histological findings of a single patient who developed late epithelial downgrowth of donor origin after Descemet stripping automated endothelial keratoplasty (DSAEK).
METHODS: A 70-year-old woman underwent uneventful DSAEK for Fuchs dystrophy in the right eye. The donor had a thickened graft edge for 2 clock hours laterally. She recovered 20/40 vision by 3 months after operation and was maintained on daily prednisolone acetate drops. Three years postoperatively, a routine examination revealed signs of an asymptomatic epithelial downgrowth exhibited by synechiae and ectropion uvea at the area of the thickened donor edge. Six months later, a faint retrocorneal membrane limited to the donor periphery and contiguous with the thick edge was noted. Visual acuity and intraocular pressure remained unchanged. She was followed for the next 15 months, without intervention until the retrocorneal membrane grew centrally, resulting in graft edema. The iris synechiae remained unchanged. Repeat DSAEK, without iridectomy, was performed with confirmation of epithelial downgrowth of donor origin. Six months postoperatively, the patient has done well without sequela of residual downgrowth.
RESULTS: Histopathological evaluation showed epithelial downgrowth, emanating from thickened donor edge onto the posterior graft surface. The anterior donor surface (interface) was devoid of downgrowth. X and Y DNA analysis confirmed the downgrowth of male origin (donor) in this female patient.
CONCLUSIONS: Donor-derived epithelial downgrowth can occur after DSAEK. Although it can result in graft failure, it behaves much less aggressively than expected and observation may be indicated until symptomatic graft edema occurs. Repeat DSAEK, not penetrating keratoplasty, may be curative.
Mark S Gorovoy; Arlene Ratanasit
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Publication Detail:
Type:  Case Reports; Journal Article    
Journal Detail:
Title:  Cornea     Volume:  29     ISSN:  1536-4798     ISO Abbreviation:  Cornea     Publication Date:  2010 Oct 
Date Detail:
Created Date:  2010-09-24     Completed Date:  2010-11-22     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8216186     Medline TA:  Cornea     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1192-4     Citation Subset:  IM    
Private Practice at Gorovoy MD Eye Specialists, Fort Myers, FL, USA.
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MeSH Terms
Corneal Edema / etiology,  surgery
Descemet Stripping Endothelial Keratoplasty / adverse effects*
Epithelium, Corneal / pathology*,  surgery
Fuchs' Endothelial Dystrophy / surgery*
Postoperative Complications
Tissue Donors
Visual Acuity

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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