Recurrence Of Corneal Guttae After Dsaek: A Case Report On Contralateral Donor Grafts And Potential Mechanisms Of New Guttae Formation

Limited data exist on the recurrence of corneal guttae after Descemet stripping automated endothelial keratoplasty (DSAEK). The presence of guttae on the donor graft has often been attributed to undetected guttae during routine slit-lamp and light microscopy evaluation at the eye bank. This report describes a case of guttae occurrence after DSAEK and investigates the recipient of the contralateral donor eye.

Two DSAEK grafts from the same donor were transplanted into two separate patients diagnosed with Fuchs' endothelial corneal dystrophy. Based on preoperative light microscopy evaluation at the eye bank, donor endothelial cell density (ECD) was 2500 cells/mm² for Patient A and 2500 cells/mm² for Patient B, with no detectable guttae in either donor cornea. Over a two-year follow-up, specular microscopy was used to assess ECD and corneal morphology of both patients.

Two years postoperatively, Patient A developed nonconfluent guttae in the corneal graft with an ECD of 1730 cells/mm². In contrast, Patient B maintained a well-preserved endothelial layer with no detectable guttae and an ECD of 2050 cells/mm². 

While undetected donor guttae remain a possible explanation, this case suggests that new guttae formation can occur within the donor graft due to repopulated endothelium, as reported following Descemet stripping only. Further studies are needed to better characterize the recurrence of guttae following DSAEK, considering both donor and recipient factors.