ABSTRACT
To study the histopathological findings of the early cases of failed DSAEK grafts and to analyze the causes of graft failure. Retrospective study of 13 failed DSAEK grafts [four grafts submitted alone with no host cornea] of 12 patients. The histopathologic features are correlated with the clinical and operative findings. Significant attenuation of the endothelial cells found in 10/13 cases [77%], retained recipient Descemet's membrane in 7/13 [54%], variability of graft thickness in 5/13 [38%] and two of these had stromal irregularity. Retrocorneal fibrous membrane along the donor's Descemet's membrane was found in 4/13 [31%] resulting in endothelial detachment in one case. Eight of the nine host cornea-graft specimens were found to have: total graft-cornea detachment [in one], subtotal in four and partial [= 50% of graft length] in three. The detached flaps showed infection at the interface of the graft-host cornea in two, epithelial ingrowth and fibrous proliferation along the anterior stromal surface of the graft [one case each]. An additional histopathological finding was secondary amyloid deposition within the host stroma [in one]. Irregular or thick graft, graft-host interface fibrous/epithelial ingrowth, and infection all predispose to DSAEK failures related to graft detachment. Endothelial cells attenuation and retrocorneal fibrous membrane are major causes for primary graft failure