Abstract
P 025
Histological findings following DSAEK failure
Sonja Ute Heinzelmann, Claudia Auw-Hädrich, Philipp Maier, Daniel Böhringer, Thomas Reinhard
Universitäts-Augenklinik Freiburg
Objective
Descemet stripping automated endothelial keratoplasty (DSAEK) represents a promising alternative for penetrating keratoplasty (pKP) in Fuchs corneal endothelial dystrophy and bullous keratopathy. The major problem is reduced prognosis of vision in comparison to pKP. This seems to depend on interface that can hardly be seen at the slit lamp. The purpose of this study was to evaluate the interface for histological findings that may explain reduced vision.
Methods
We examined the corneas of 4 pseudophakic patients who underwent pKP after DSAEK because of graft failure, flap dislocation and reduced visual outcome (interval 1-7 months after DSAEK). One donor cornea was preparated mechanically by microkeratome, the other 3 by femto second laser. The sections were stained following standard protocols for HE, PAS, AMP and Goldner. Immunohistochemically (TUNEL, Caspase 3), apoptotic cells were made visible. The region of the interface was examined electron-microscopically. Corneas with Fuchs endothelial dystrophy following pKP served as controls.
Results
In all stainings, the interface could hardly be seen because of good adaptation of the graft and an irritation free wound. Neither mucopolysaccarides nor increased connective tissue could be displayed. Morphology of keratocytes appeared regular in light- and electron-microscopy. Though, electron-microscopically, interrupted collagen fibrils could be seen.
Conclusions
DSAEK represents a promising alternative to pKP in Fuchs endothelial dystrophy and bullous keratopathy especially for elderly patients as it is less invasive and provides faster visual rehabilitation. Reduced visual outcome and increased light sensitivity in comparison to pKP may be influenced by structural misalignment of the collagen fibrils. Probably, they cause optical aberrations of higher orders such as diffraction, aberration and dispersion.
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