Calcareous degeneration of host-donor interface after descemet membrane stripping with automated endothelial keratoplasty

PURPOSE: To report a case of host-donor interface calcification after Descemet membrane stripping with automated endothelial keratoplasty (DSAEK). METHODS: Review of the patient's clinical records and histopathologic examination of the donor corneal lamella from repeat DSAEK performed subsequent to the original DSAEK. RESULTS: Review of the clinical record of the patient revealed an ocular history of Fuchs dystrophy and pseudophakic bullous keratoplasty that was treated with DSAEK. She later developed corneal edema and a partially detached donor lamella and underwent repeat DSAEK. Histopathologic and transmission electron microscopic evaluations of the corneal lamella revealed calcium deposits in the host-donor interface. CONCLUSIONS: Calcareous degeneration of the host-donor interface after DSAEK is reported as a novel postoperative complication of DSAEK. Calcium deposits in the host-donor interface after DSAEK should be considered in the differential diagnosis of interface opacity after this procedure, particularly in patients with predisposing systemic or local risk factors such as retained phosphate-containing viscoelastic material, excessive postoperative inflammation, or use of phosphate-buffered, postoperative topical medications.