Original articleMyofibroblast Metaplasia After Descemet Membrane Endothelial Keratoplasty
Section snippets
Methods
Ninety consecutive DMEK surgeries were performed over a period of 12 months starting in June 2009. While 85 grafts stayed clear with marked improvement of visual acuity, 5 grafts were classified as early graft failure. Descemet membrane was chronically detached and graft failure was attributed to this fact in 3 of the 5 patients, while slit-lamp optical coherence tomography (SL-OCT, Heidelberg Engineering, Lübeck, Germany) confirmed complete graft adherence in the 2 patients who are presented
Results
Light microscopy revealed distinct corneal endothelial cell attenuation. Mean endothelial cell count was 4.2 ± 0.8 cells (range, 3-5) and 5.0 ± 2.5 cells (range, 1-7) (normal range: >120 cells) measured in 8 consecutive high-power fields (magnification ×400) per slide in 5 consecutive serial sections (Figure 2, Left). Most of the remaining endothelial cells had an elongated fibroblast-like appearance (Figure 2, Top right). Immunostaining revealed the presence of α-smooth muscle actin (α-SMA)
Discussion
To date, little information exists to explain impaired function after posterior lamellar surgery in patients with clinically attached grafts. Our findings are consistent with histopathologic observations after failed DSAEK, indicating that endothelial cell loss might be a reason for persistent corneal edema and malfunction after surgery.7, 8, 9, 10 However, DMEK grafts can also fail in patients where a close to normal endothelial cell count was obtained by in vivo microscopy.5 This finding may
Ludwig M. Heindl, MD, is a staff member of the Department of Ophthalmology at the Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany. He graduated from the Erlangen Medical School in 2006 and received training in clinical ophthalmology with Professor Kruse and ophthalmic pathology with Professor Naumann. His research interests include applied pathology of the eye, in particular of the cornea as well as (peri-)ocular tumors.
References (15)
- et al.
Descemet's membrane endothelial keratoplasty: prospective multicenter study of visual and refractive outcomes and endothelial survival
Ophthalmology
(2009) - et al.
Split cornea transplantation for 2 recipients: a new strategy to reduce corneal tissue cost and shortage
Ophthalmology
(2011) - et al.
Histopathologic examination of failed grafts in Descemet's stripping with automated endothelial keratoplasty
Ophthalmology
(2009) - et al.
A clinicopathologic series of primary graft failure after Descemet's stripping and automated endothelial keratoplasty
Ophthalmology
(2009) - et al.
Retrocorneal fibrous membranes in failed corneal grafts
Am J Ophthalmol
(1993) - et al.
Preliminary clinical results of Descemet membrane endothelial keratoplasty
Am J Ophthalmol
(2008) - et al.
A method to confirm correct orientation of Descemet membrane during Descemet membrane endothelial keratoplasty
Am J Ophthalmol
(2010)
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Ludwig M. Heindl, MD, is a staff member of the Department of Ophthalmology at the Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany. He graduated from the Erlangen Medical School in 2006 and received training in clinical ophthalmology with Professor Kruse and ophthalmic pathology with Professor Naumann. His research interests include applied pathology of the eye, in particular of the cornea as well as (peri-)ocular tumors.
Friedrich E. Kruse, MD, is Professor and Chairman, Department of Ophthalmology at the Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany since 2004. After graduation from Heidelberg Medical School in 1984, he worked from 1988 to 1991 at the Bascom Palmer Eye Institute, Miami, Florida. His research interests include cellular and molecular biology of the ocular surface corneal transplantation and laser application.