Histopathology of Corneal Pathology in DescemetStripping Endothelial Keratoplasty Specimens

1
Histopathology of Corneal Pathology in
Descemet-Stripping Endothelial Keratoplasty
Specimens

• J. N. Ulrich¹ R. C. Eagle²
• ¹Geisinger Medical Center, Danville, PA
• ²Wills Eye Institute, Philadelphia, PA

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Purpose

• Descemet-stripping with endothelial keratoplasty
  (DSEK) has become increasingly popular since its
  description by Price Price in 2005¹. In
  diseases limited to the inner cornea (e.g. Fuchs
  endothelial dystrophy (FED), pseudophakic bullous
  keratopathy (PBK) ) DSEK represents a valuable
  alternative to conventional penetrating
  keratoplasty. This study describes the
  histopathology of Descemet membranes (DM)
  obtained by DSEK.

¹Price FW Jr, Price MO. Descemet's stripping with
endothelial keratoplasty in 50 eyes a refractive
neutral corneal transplant. J Refract Surg. 2005
Jul-Aug21(4)339-45.
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Methods

• 110 consecutive corneal specimens from
  patients undergoing DSEK for FED and PBK between
  January 2006 and April 2007 were processed at the
  Department for Ocular Pathology at Wills Eye
  Institute, Philadelphia. Specimens were stained
  with haematoxylin and eosin (HE) as well as with
  perodic acid Schiff's reagent (PAS) and assessed
  by light microscopy.

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Results

• Folded segments of DM without associated stroma
  were identified. 76 cases of FED were
  characterized by irregularly thickened DM,
  studded with guttate excrescences as well as
  relatively preserved endothelium with melanin
  granules. 25 cases of PBK showed a regular DM and
  severely atrophic endothelium. Guttae evidenced
  underlying endothelial dystrophy in 9 cases of
  PBK.

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FED
preserved endothelium
melanin granules
guttate excrescence
6
PBK
Atrophic endothelium
7
PBK with underlying FED
Atrophic edndothelium
Guttate excrescence
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A- FED B- PBK with underlying FED C- PBK
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Conclusion

• Histopathologic examination easily provides
  diagnostic confirmation of FED and PBK in DSEK
  specimens, which should be submitted.