Textural interface opacity after Descemet-stripping automated endothelial keratoplasty

Abstract

To describe cases of interface haze, also known as textural interface opacity, after Descemet-stripping automated endothelial keratoplasty (DSAEK). Department of Cornea, External Disease, and Refractive Surgery Service, Duke Eye Center, Durham, North Carolina, USA. Retrospective case series. Patients' clinical and demographic characteristics, cornea donor information, surgical technique, histopathology, and anterior segment optical coherence tomography (OCT) were reviewed retrospectively and clinical outcomes reported. The interface haze that developed after DSAEK comprised 2 types of textural interface opacity; that is, total (11 cases) and partial (3 cases). The time of onset of textural interface opacity ranged from 1 day to 7 weeks postoperatively. Although most patients with textural interface opacity showed improvement, with a corrected distance visual acuity better than 20/50, 3 had persistent decreased visual acuity and required repeat DSAEK. Seven eyes had concurrent phacoemulsification with intraocular lens implantation and DSAEK. The corneal graft was inserted with an Endoserter device in 11 eyes, an insertion forceps in 2 eyes, and a cystotome needle in 1 eye. Histopathology of the grafts of eyes that required repeat DSAEK showed no inflammation, no foreign-body deposit, and no fibrosis. Anterior segment OCT showed increased hyperreflectivity in the interface. Although the etiology of textural interface opacity is unclear, it may be related to retained ophthalmic viscosurgical device (OVD) or an adhesive property of the OVD used during the surgery. Although most cases resolve with time, repeat DSAEK may be an effective treatment for refractory cases. Dr. Kim is a consultant to Ocular Systems, Inc. No other author has a financial or proprietary interest in any material or method mentioned.