Autologous Descemet Stripping Automated Endothelial Keratoplasty to Eliminate Endothelial Rejection in Eyes at High Risk

Cornea. 2020 May;39(5):666-668. doi: 10.1097/ICO.0000000000002184.


Purpose: To determine whether autologous Descemet stripping endothelial keratoplasty is technically feasible and whether it eliminates the risk of endothelial rejection in "only eyes" at high risk of immunological rejection.

Methods: This is a prospective observational interventional study from 2016 to 2018 with a 24-month follow-up in a tertiary-level corneal referral center, Forlì, Italy. One 25-year-old woman with failed penetrating keratoplasty after endothelial rejection in the context of chronic panuveitis and a blind fellow eye due to retinal detachment underwent autologous Descemet stripping automated keratoplasty. An endothelial graft was harvested from the fellow eye by performing a hinged, microkeratome-assisted superficial stromal flap, with removal of the central posterior stromal bed. The posterior lamellar graft created was then transplanted into the other eye using a standardized Descemet stripping automated endothelial keratoplasty (DSAEK) technique. Main outcome measures were endothelial rejection, best spectacle-corrected visual acuity, and endothelial cell density.

Results: No endothelial rejection was seen during the 2-year follow-up duration. Stable improvement in best spectacle-corrected visual acuity from 0.2 to 0.4 (decimal Snellen) was observed. Endothelial cell density of 1465 (cells/mm) was recorded at the final follow-up.

Conclusions: The use of this repeatable technique to harvest and transplant an autologous DSAEK graft eliminates endothelial rejection in high-risk eyes.

Publication types

  • Case Reports
  • Observational Study

MeSH terms

  • Adult
  • Corneal Diseases / diagnosis
  • Corneal Diseases / surgery*
  • Descemet Stripping Endothelial Keratoplasty / methods*
  • Endothelium, Corneal / transplantation*
  • Female
  • Follow-Up Studies
  • Graft Rejection / prevention & control*
  • Graft Survival
  • Humans
  • Prospective Studies
  • Tissue Donors
  • Transplantation, Autologous
  • Visual Acuity*