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2020 OMIG Abstract

Clinicopathologic correlations of retrocorneal membranes associated with endothelial corneal graft failure

Andrea Naranjo, MD^1,2, Nathan Pirakitikulr, MD, PhD^1,3, Daniel Pelaez, PhD⁴,
Alfonso L. Sabater MD, PhD^1,4, Pedro Monsalve MD¹, Jaime D. Martinez, MD¹, Guillermo Amescua, MD¹, Anat Galor, MD, MSPH^1,3, and Sander R. Dubovy, MD^1,2
1Anne Bates Leach Eye Center; ²Florida Lions Ocular Pathology Laboratory; ³Miami Veterans Administration Medical Center; ⁴Dr. Al-Rashid Orbital Vision Research Center; ⁵Corneal and Ocular Surface Regenerative Medicine Center; Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL

Design: Retrospective case series.

Methods: The specimens and medical records of the patients diagnosed with clinically significant retrocorneal membranes associated with DSAEK failure at the Bascom Palmer Eye Institute or the University of Miami Veterans Hospital between October 2015 and March 2020, were reviewed for demographics, clinical presentation, comorbidities and surgeries performed. Histopathological analysis was performed on Hematoxylin and eosin and periodic acid-Schiff sections. Immunohistochemical studies were performed for smooth muscle actin (α-SMA), pancytokeratin and CK7. Immunofluorescence was performed for vimentin, N-cadherin, ROCK1, RhoA, ZEB1 and Snail.

Results: A total of seven patients (3 males and 4 females) were identified to have a clinically significant retrocorneal membranes at the time of graft failure. The average age at the time of first DSAEK was 70 years (range: 55-85). All patients were pseudophakic and had a glaucoma drainage device in place; one had a history of failed DSAEK. Ranging from 0 to 47 months after surgery, a variably thick retrocorneal fibrous membrane was observed, eventually leading to graft failure. Four patients underwent subsequent penetrating keratoplasty and three underwent repeat DSAEK. On histopathologic evaluation, a pigmented fibrocellular tissue was identified along the posterior margin of the corneas and DSAEK buttons in all cases. Further characterization with immunohistochemistry and immunofluorescence demonstrated membranes to be negative for pancytokeratin and positive for α-SMA, vimentin, CK7, N-cadherin, ZEB1, Snail, ROCK1 and RhoA.

Conclusion: Fibrocellular retrocorneal membrane proliferation may be associated with DSAEK failure in patients with previous glaucoma drainage device surgery. Our results demonstrate myofibroblastic differentiation and a lack of epithelial differentiation. Positivity for markers of an endothelial to mesenchymal transition indicates possible endothelial origin and could be the hallmark for future targeted pharmacotherapy.

Disclosure: N

Support: This research was supported by the Florida Lions Eye Bank (A Naranjo, P Monsalve and SR Dubovy), Department of Veterans Affairs, Veterans Health Administration, Office of Research and Development, Clinical Sciences Research I01 CX002015 (A Galor), Biomedical Laboratory R&D (BLRD) Service I01 BX004893 (A Galor), Department of Defense GW190010 (A Galor), R01EY026174 (A Galor), NIH Center Core Grant P30EY014801 and Research to Prevent Blindness Unrestricted Grant.

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