Wave-like opacities at the interface after descemet stripping automated endothelial keratoplasty

Purpose: To describe a peculiar postoperative complication of Descemet stripping automated endothelial keratoplasty (DSAEK), characterized by wave-like opacities at the donor–recipient interface. Methods: Wave-like opacities at the interface were observed a few days after surgery, in 1 eye of 2 patients who had undergone uneventful DSAEK for Fuchs endothelial dystrophy. DSAEK was performed using microkeratome-prepared lamellar grafts obtained from organ culture–preserved corneas. In the recipient, the 8.50-mm graft was inserted using a pull-through technique. Postoperative follow-up was 12 months in case 1 and 6 months in case 2. Results: The wave-like opacities were whitish and involved the central cornea in both cases; in case 2, they were associated with hyperreflective dots. Despite intensive topical therapy with dexamethasone 0.2%, the opacities at the interface persisted during follow-up. However, visual acuity progressively improved; at last examination, uncorrected and corrected distance visual acuity were, respectively, 20/40 and 20/25 in case 1 and 20/30 and 20/20 in case 2. Optical coherence tomography showed that the interface reflectivity was slightly higher than it was in DSAEK cases without opacities. The central thickness of the whole cornea and the lamella were 563 and 93 μm in case 1 and 603 and 140 μm in case 2. Postoperative endothelial cell loss was 37% in case 1 and 24% in case 2. Conclusions: Wave-like opacities at the donor–recipient interface are a rare complication of DSAEK surgery of unclear origin. Although interface opacities involve the central cornea and persist after surgery, good postoperative visual recovery can be achieved.