Guttae in the donor after Descemet-stripping automated endothelial keratoplasty

Background: Descemet-stripping automated endothelial keratoplasty (DSAEK) has become the surgical technique of choice for endothelial disorders, supplanting penetrating keratoplasty (PK). Although case reports have described the presence of guttae after PK, there have been no published reports of guttae occurring in the graft after DSAEK. Methods: Case report of DSAEK in an 82-year-old female with pseudophakic bullous keratopathy Results: Routine follow-up demonstrated the presence of guttae in the graft as early as the first post-operative day, with stromal edema being observed by the second post-operative week. The patient has had a stable visual acuity and exam for 16 months since DSAEK, with moderate guttae and trace stromal edema. The initial procedure was unremarkable, although another bubble was placed on the first post-operative day because of a cleft between the host and graft. Conclusions: Guttae may occur in the donor cornea after DSAEK, as previously seen after PK. Potential causes include problems with tissue preparation and grading, tissue misidentification, or surgical manipulation. Methods of elucidating whether there is an underlying predisposition to guttae formation in certain grafts, continued vigilance to ensure the highest-quality donor tissue, and meticulous surgical technique will be necessary as the use of DSAEK continues to grow.