Descemet's stripping endothelial keratoplasty: an effective treatment for toxic anterior segment syndrome with histopathologic findings.

Objective: To report Descemet's stripping endothelial keratoplasty (DSEK) as a treatment for corneal edema associated with toxic anterior segment syndrome.

Methods: A 75-year-old woman presented with decreased vision in her left eye after uneventful phacoemulsification. She was diagnosed with toxic anterior segment syndrome and a DSEK was performed. Histologic sections were examined after staining with hematoxylin and eosin, periodic acid Schiff, and Masson trichrome; immunoperoxidase reactions were used to identify cytokeratins, vimentin, and alpha-smooth muscle actin.

Results: The corneal endothelium was selectively replaced by the DSEK technique. Descemet's membrane and endothelium were stripped from the recipient's stroma, and an 8-mm-diameter donor button consisting of posterior stroma and healthy endothelium was folded and implanted through a 5-mm incision. An air bubble was used to press the donor tissue against the recipient cornea, allowing it to attach without sutures. Corneal edema and visual acuity improved. Histopathologic evaluation of the DSEK specimen disclosed a multilaminar retro-Descemet's fibrous membrane in which many of the constituent fibroblasts contained scattered pigment granules and stained for both vimentin and cytokeratin with immunoperoxidase methods.

Conclusions: To the best of our knowledge, this is the first reported case of successful DSEK in a patient with corneal decompensation resulting from toxic anterior segment syndrome exhibiting a retrocorneal fibrous membrane. Visual recovery was rapid, and refractive changes were minimal compared with traditional penetrating keratoplasty. The immunoperoxidase staining strongly suggests that the retrocorneal fibrous membrane was created by dysplastic corneal endothelial cells.