Guttae in the donor after Descemet-stripping automated endothelial keratoplasty

Abstract

Guttae may occur in the donor cornea after DSAEK, as previously seen after PK. Potential causes include problems with tissue preparation and grading, tissue misidentification, or surgical manipulation. Methods of elucidating whether there is an underlying predisposition to guttae formation in certain grafts, continued vigilance to ensure the highest-quality donor tissue, and meticulous surgical technique will be necessary as the use of DSAEK continues to grow.

Corneal Guttae After Descemet Membrane Endothelial Keratoplasty

“…Occurrence of corneal guttae in this case series could be detected within the first postoperative month which corroborates previous reports on the early guttae occurrence after DSAEK and DMEK. 9,11 Along with the fact that corneal guttae have been observed for patients with surgery indications other than FECD, 6–10,12,15 this supports the hypothesis that the corneal guttae originate from the donor tissue. Differences in the reported postoperative incidence of corneal guttae could then either be due to differences in the screening protocol between eye banks providing the corneal grafts or be due to differences in the postoperative detection of corneal guttae.…”

“…This may result in donor tissue containing guttae being released for transplantation and guttae becoming visible postoperatively. [6][7][8][9][10][11][12][13][14][15] Reported incidences of postoperative corneal guttae varies in the literature for penetrating and endothelial keratoplasty. For penetrating A-E, Central specular microscopy images of case #4 who underwent primary DMEK for pseudophakic bullous keratopathy.…”

“…This may result in donor tissue containing guttae being released for transplantation and guttae becoming visible postoperatively. 6–15 Reported incidences of postoperative corneal guttae varies in the literature for penetrating and endothelial keratoplasty. For penetrating keratoplasty (PK), corneal guttae were observed in 13% to 26% of the grafts, 6,10,15 for Descemet stripping automated endothelial keratoplasty (DSAEK) in 3% of the grafts (from the same study that reported a rate of 13% after PK), 6 and for DMEK in 4% to19% of the eyes.…”

“…6 The detection of guttae, however, can be challenging, and the occurrence of guttae after corneal transplantation has been reported. [6][7][8][9][10][11][12][13][14][15] Isolated corneal guttae or patches of confluent corneal guttae have been identified in up to 25% of corneal grafts after penetrating keratoplasty 6 and in up to 18.7% of corneal grafts after Descemet membrane endothelial keratoplasty (DMEK). 14 Because DMEK is nowadays a preferred treatment option for endothelial diseases, in the current study, we report in more detail on the different appearances of corneal guttae after DMEK and on the longer-term effect of the guttae on clinical outcomes.…”