Transcript The Histology of Graft Adhesion in Descemet`s Stripping with

The Histology of Graft Adhesion in Descemet
Stripping with Automated Endothelial
Keratoplasty
Matthew Caldwell, Alan Proia, Francis DeCroos,
and Natalie Afshari
Duke Eye Center
Authors have no financial interest.
Supported by an award from Research to Prevent Blindness
PURPOSE
• BACKGROUND
–DSEK is the surgery of choice for endothelial
dysfunction.
–The most common complication is graft
detachment.
–The mechanism of graft adhesion is poorly
understood.
• OBJECTIVE
–To describe the histologic findings of graft
adhesion in DSEK
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METHODS
• IRB approval
• Search of DSEK surgeries followed by PK
• Clinical history reviewed
• Slides cut and stained with
–H&E
–PAS
–Colloidal Iron
RESULTS
Eyes with PK following DSEK
Age
Sex/Race
History
1
88
F/W
Fuchs,PCIOL, DSEK
458
2
79
M/W
PCIOL,PK, DSEK
103
3
81
M/W
PCIOL, tube x2, PK x2, DSEK
232
4
90
F/W
ACIOL, DSEK
573
5
87
F/W
Tube x3, hypotony, ACIOL, DSEK
138
6
56
M/B
Tube x2, CPC, PCIOL, DSEK
373
7
23
M/B
Peters, glaucoma surg x3, PK, DSEK x2
75
8
53
F/W
Fuchs, PK, PCIOL, DSEK
373
9
59
F/I
PCIOL, PK, tube, synechiolysis, DSEK
490
10
64
F/W
Fuchs, PK, PCIOL, DSEK
511
Pseudophakic=10 (ACIOL=2)
Glaucoma w/ tube = 5
Failed graft prior to DSEK = 6
Duration
}
All high risk patients
with multiple ocular
comorbidities
Interface Findings
• The interface was barely
perceptible in most
cases. Keratocyte
density was unaltered at
the interface.
• In 3 cases, increased
cellularity was noted
along the unopposed
stromal edge in areas of
detachment.
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Interface Material
• Pigment granules and debris were seen in the
interface to some extent in nearly all cases. The
presence of glycosaminoglycans was not
demonstrated with colloidal iron stain.
6
Interface Descemet Membrane
• Descemet membrane was present in the
peripheral interface in 8 of 10 cases.
Interface Descemet Membrane
Of the 10 specimens, 4 were completely attached grossly, 3 were partially
separated, and 3 were completely separated. Interface Descemet membrane
(DM) was noted in all three groups. In all groups the interface DM was
preferentially adherent to the graft rather than the posterior stroma.
•
Completely
Attached
(4/10)
Partially
Separated
(3/10)
+DM in 4/4
+DM in 2/3
More adherent to
graft at split edges
•
More adherent to
graft in 1, free
floating in the other
Completely
Separated
(3/10)
+DM in 2/3
•
Adherent only to
graft in both
Peripheral Splitting Artifact
Peripheral splitting was present at at least one edge of all attached cases.
This is presumed artifact due to shearing forces from specimen sectioning.
This was present independent of the presence of Descemet membrane.
Peripheral splitting artifact. Note preferential
adhesion of Descemet membrane to the graft.
Other Findings
Other anterior and posterior findings unrelated to the
interface were present in many cases.
• Fibrocollagenous pannus
• Anterior stromal scarring
• Paucity of endothelial cells
• Retrocorneal membrane
Retrocorneal membrane
CONCLUSIONS
• DSEK grafts form adhesion without scarring
or keratocyte proliferation.
• Pigment granules and Descemet membrane
are common in the interface.
• DSEK grafts form a firm attachment to
Descemet membrane (relative to the adhesion
of DM to the native posterior stroma)
• Stripping of Descemet’s membrane may be
unnecessary for graft adhesion