ABSTRACT: To describe the clinicopathologic findings in failed Descemet-stripping automated endothelial keratoplasty (DSAEK) grafts.
Retrospective, interventional case series.
New York Eye and Ear Infirmary.
Twenty-one patients with 22 failed DSAEK grafts treated between March 1, 2006 and February 1, 2008.
Repeat DSAEK or penetrating keratoplasty were performed in the eyes with failed grafts. All failed grafts were examined histopathologically.
Histopathologic parameters studied in failed DSAEK grafts included endothelial cell count, interface characteristics, retrocorneal membrane formation, inflammation, and immunoreactivity for herpes simplex virus type 1 (HSV-1) antigen.
DSAEK failure was strongly associated with postoperative lenticle dislocation. Graft failure was primary in 19 DSAEKs and secondary to rejection, eccentric trephination with epithelial ingrowth, or bacterial infection in the remaining 3. All failed grafts demonstrated endothelial hypocellularity and stromal edema. Additional findings included stromal inflammation (68%), interface fibrosis (50%), retrocorneal membrane (36%), unplanned retention of Descemet membrane (14%), immunoreactivity for HSV-1 (14%), paucicellular stroma (14%), and uneven trephination with epithelial ingrowth (5%).
Most DSAEK failures are secondary to endothelial cell loss. Other contributing factors include interface fibrosis, retrocorneal membrane formation, retained host Descemet membrane, uneven trephination, epithelial ingrowth, graft rejection, and infection.
American journal of ophthalmology 09/2009; 148(5):752-759.e2. · 3.83 Impact Factor
ABSTRACT: A 70-year-old woman presented with a slow-growing right lower eyelid lesion. Histopathologic and immunohistochemical evaluation of an excisional biopsy revealed a neuroendocrine neoplasm, consistent with a typical carcinoid tumor. Systemic investigation for occult visceral primary tumor was negative. Re-excision of the lesion for free surgical margins was performed. Eight months later, the patient remains well with no evidence of other primary malignancy or metastatic disease.
Ophthalmic plastic and reconstructive surgery 25(4):318-20. · 0.69 Impact Factor
ABSTRACT: Subepidermal calcified nodule uncommonly involves the eyelid, and the authors report their experience with 9 cases of this entity. Most lesions appeared as solitary, raised, tan, or white nodules on the upper eyelid or medial canthal skin of healthy, young patients. The diagnosis was not suspected in any of the patients. The most common preoperative diagnosis was a "cyst." Excisional biopsy was performed in all cases and was curative with the exception of one recurrence. Histopathologic evaluation showed basophilic deposits beneath acanthotic and papillomatous epidermis on hematoxylin and eosin-stained preparations. The deposits stained with von Kossa's stain for calcium and were surrounded by foreign body reaction. Ophthalmologists should be aware that subepidermal calcified nodule is a benign lesion that can occur in the eyelid skin.
Ophthalmic plastic and reconstructive surgery 25(6):489-90. · 0.69 Impact Factor