Fibrocellular Contraction of a Lamellar Posterior Corneal Graft

PURPOSE To report a case of progressive fibrotic contraction of the posterior lamellar graft after initially successful Descemet's stripping automated endothelial keratoplasty (DSAEK). METHODS Retrospective report of clinical data and histopathological analysis of excised corneal tissue. RESULTS A 63-year-old woman underwent uncomplicated DSAEK in her left eye due to endothelial dystrophy. During the first months after surgery, her visual acuity was 0.3, and a semilunar contraction gradually appeared at the edge of the graft. Over the following months, the fibrotic changes progressed and visual acuity decreased, with no improvement after uncomplicated cataract surgery. A successful penetrating keratoplasty was performed, and the excised corneal button with an attached posterior lamellar graft was histologically examined. The affected part of the graft consisted of a thickened fibrocellular tissue positive for glycosaminoglycans and smooth muscle actin. CONCLUSIONS The present case demonstrates asymmetric fibrotic contraction of a DSAEK graft.