The Histology of Graft Adhesion in Descemet Stripping with Endothelial Keratoplasty

Purpose To describe the histologic findings of full-thickness corneas from penetrating keratoplasty (PK) in 10 patients with a prior history of Descemet stripping with endothelial keratoplasty. Design Retrospective review of the histopathology of 10 PK specimens. Methods We reviewed histologic sections stained with hematoxylin and eosin, periodic acid-Schiff, and colloidal iron stains from 10 PK specimens, which had been trisected and submitted in their entirety. Clinical data were abstracted from the medical record. Results The interface between host and graft in most cases was barely perceptible with minimal changes in the degree of tissue eosinophilia, a subtle increase in keratocyte cellularity focally, or the presence of melanin granules within keratocytes. Residual host Descemet membrane (DM) was found in 8 of the 10 cases, most often at the edges of the graft. In no case did the presence of DM appear to hinder graft adhesion. Conclusion The adhesion of Descemet stripping with endothelial keratoplasty grafts is not associated with significant scarring or keratocyte proliferation. Contrary to previous assumptions, retained DM did not appear to hinder graft adhesion, raising the possibility that removal of DM may be unnecessary for endothelial transplantation.