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Dark endothelial spots after Descemet's membrane endothelial keratoplasty may impose as recurrent Fuchs' dystrophy

Poster Details

First Author: R.Birbal THE NETHERLANDS

Co Author(s):    V. Zygoura   L. Baydoun   G. Melles              

Abstract Details


To evaluate the clinical significance of dark spots in the donor endothelial cell layer as observed with specular microscopy, in patients who underwent Descemet Membrane Endothelial Keratoplasty (DMEK) for Fuchs endothelial dystrophy (FED).


Netherlands Institute for Innovative Ocular Surgery / Tertiary referral center.


78 DMEK eyes were retrospectively screened for the presence of dark spots and/or associated endothelial cell changes and cell density (ECD) up to 7 years after DMEK, using specular microscopy.


A total of 48/78 eyes (61.5%) showed a normal endothelial cell layer (Group 0). In the remaining 30/78 eyes, various dark spots with or without altered endothelial cell morphology could be categorized into three groups. In 9/78 (11.5%) eyes the dark spots were classified as artifacts (Group I) and in 10/78 (12.8%) eyes as 'superimposed' dots (Group II), i.e. optical irregularities at a level slightly anterior to the endothelial cell layer. In 11/78 (14.1%) eyes, endothelial cells showed a dark greyish discoloration (Group III). Two of these eyes were associated with an allograft rejection and three developed secondary graft failure.


Dark endothelial spots after DMEK for FED may not represent recurrent disease, but may result from tissue irregularities just anterior to the graft. However, if associated with changes in endothelial cell morphology, and/or nuclear activation, dark discolorations may indicate �Â�´cellular stress�Â�´ heralding a (subclinical) allograft rejection or secondary graft failure.

Financial Disclosure:

receives consulting fees, retainer, or contract payments from a company producing, developing or supplying the product or procedure presented

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