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Persistent Corneal Opacity After Descemet Stripping Automated Endothelial Keratoplasty Suggesting Inert Material Deposits Into the Interface

Chhadva, Priyanka BS*; Cabot, Florence MD*,†; Ziebarth, Noel PhD; Kymionis, George D. MD, PhD§; Yoo, Sonia H. MD*,†

doi: 10.1097/ICO.0b013e3182a1bc49
Case Report

Purpose: To report a case of interface deposits after Descemet stripping automated endothelial keratoplasty (DSAEK) imaged by means of an electron microscope.

Methods: An 88-year-old man was referred with a history of corneal edema resulting from pseudophakic bullous keratopathy. A DSAEK was performed on his left eye without complications; however, the follow-up examination revealed a well-attached graft with persistent interface opacities at the donor–recipient interface. The DSAEK was repeated in this eye 1 year after the first surgery because of these corneal opacities that interfered with his vision.

Results: In the immediate postoperative period, the patient had adequate visual acuity with intact graft placement and a clear interface. Pathology and electron microscope analysis were performed on the removed endothelial graft, which revealed diffuse particles on the stromal surface of the endothelial graft.

Conclusions: A repeated DSAEK procedure sufficiently removed this patient's corneal opacities and improved the visual acuity. The opacity is believed to have occurred because of residual viscoelastic material, which was used to maintain anterior chamber volume during surgery. This solution must be thoroughly removed to avoid similar complications.

*University of Miami, Miller School of Medicine, Miami, FL;

Bascom Palmer Eye Institute, Miami, FL;

Biomedical Atomic Force Microscopy Laboratory, Department of Biomedical Engineering, University of Miami College of Engineering, Coral Gables, FL; and

§University of Crete, Crete, Greece.

Reprints: Sonia H. Yoo, Bascom Palmer Eye Institute, 900 NW, 17th St, Miami, FL, 33126 (e-mail:

The authors have no funding or conflicts of interest to disclose.

Received April 12, 2013

Accepted June 20, 2013

© 2013 by Lippincott Williams & Wilkins.