Microbial keratitis after descemet stripping automated endothelial keratoplasty
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Updated: Jun 3, 2026
Corneal Donor Tissue Preparation for Descemet's Membrane Endothelial Keratoplasty
Published on: September 17, 2014
Namrata Sharma1, Prakash Chand Agarwal, Chandra Shekhar Kumar
1Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India. namrata103@hotmail.com
Background:
To report two cases of corneal infection after Descemet stripping automated endothelial keratoplasty (DSAEK).
Methods:
Two eyes of two patients demonstrated varying clinical presentations of microbial keratitis after DSAEK. At the initial presentation, the keratitis involved the host cornea alone in case 1, whereas in case 2, the posterior lamellar disk alone was involved. A pair of microvitrectomy scissors was used in case 2 from the side port to obtain a 2-mm sample of the posterior lamellar disk for microbiologic evaluation. The keratitis did not respond to medical therapy, and therapeutic penetrating keratoplasty was performed to resolve the infection in both the eyes. The main outcome measures were resolution of infection, absence of recurrence of keratitis, graft clarity, and visual outcome.
Results:
There was complete resolution of infection after full thickness therapeutic grafts with best-corrected visual acuities of 20/60 and 20/40, respectively.
Conclusions:
Initial presentation of microbial keratitis after DSAEK may involve either the host or the posterior lamellar disk alone. A microvitrectomy scissors through the side port may be used for biopsy of posterior lamellar disk in recalcitrant infection.
Insights
Corneal infections following Descemet stripping automated endothelial keratoplasty (DSAEK) can affect either the host cornea or the donor tissue. Prompt biopsy and therapeutic penetrating keratoplasty are crucial for resolving these serious post-keratoplasty infections.
Area of Science:
- Ophthalmology
- Microbiology
- Transplantation Surgery
Background:
- Descemet stripping automated endothelial keratoplasty (DSAEK) is a common procedure for endothelial dysfunction.
- Corneal infections are a rare but serious complication following DSAEK.
- Understanding the presentation and management of post-DSAEK keratitis is vital.
Observation:
- Two cases of microbial keratitis after DSAEK are presented with distinct clinical presentations.
- Case 1: Keratitis involved the host cornea.
- Case 2: Keratitis involved the posterior lamellar disk alone, requiring targeted biopsy.
Findings:
- Microbial keratitis post-DSAEK can present with varied localization (host vs. donor tissue).
- Microvitrectomy scissors facilitated biopsy of the posterior lamellar disk in one case.
- Therapeutic penetrating keratoplasty led to complete resolution of infection in both cases.
Implications:
- Early diagnosis and appropriate biopsy techniques are essential for managing post-DSAEK infections.
- Aggressive surgical management, including therapeutic penetrating keratoplasty, can achieve favorable visual outcomes.
- This report highlights the importance of considering localized infections within the graft or host post-DSAEK.
