A clinicopathologic series of primary graft failure after Descemet's stripping and automated endothelial keratoplasty.

Purpose: To characterize the clinical and histologic features of primary graft failure after Descemet's stripping and automated endothelial keratoplasty (DSAEK).
Design: Retrospective observational case series.
Participants: Sixteen cases of DSAEK graft failure from 15 patients, all with detailed histologic examination of failed graft tissue.
Methods: Hematoxylin-eosin, periodic acid-Schiff staining, and light microscopy were used to examine the failed DSAEK graft tissue from all patients.
Main Outcome Measures: Examination of specimens for corneal endothelial cell viability and host-donor interface characteristics.
Results: Clinical history revealed that 88% (14/16) of studied DSAEK grafts detached before failure, and pathologic examination found that 75% (12/16) of failed grafts had atrophic corneal endothelium. Examples of residual host Descemet's membrane in the graft site and improper donor trephination were also identified.
Conclusions: Marked loss of the corneal endothelium is the prominent feature of primary DSAEK graft failure. Examples of surgical features, such as incomplete Descemet's stripping and residual full-thickness cornea with a DSAEK graft, are shown.