Retrocorneal Membrane Proliferation May Be Linked to Descemet Stripping Automated Endothelial Keratoplasty Failure

TO GO WITH AFP STORY BY DELPHINE THOUVENOT – Surgeons perform a corneal transplant, on April 2, 2012 at the Edouard Herriot hospital in Lyon, southeastern France. AFP PHOTO JEFF PACHOUD (Photo credit should read JEFF PACHOUD/AFP via Getty Images)
Researchers sought to determine whether fibrocellular retrocorneal membrane proliferation is linked to DSAEK failure in patients who received glaucoma drainage device surgery.

Fibrocellular retrocorneal membrane proliferation may be linked to Descemet stripping automated endothelial keratoplasty (DSAEK) failure in patients who received glaucoma drainage device surgery, according to study results published in the American Journal of Ophthalmology.

DSAEK is a preferred treatment for endothelial cell dysfunction and severe anterior segment disease; however, this procedure may lead to complications including graft failure and retrocorneal membranes. Data on the nature of retrocorneal membranes in DSAEK are limited; therefore, the objective of this study was to assess and characterize retrocorneal membranes associated with DSAEK and identify their source along with potential future pharmacotherapies.

In this retrospective case series, researchers evaluated specimens and medical records of patients with clinically significant retrocorneal membranes that led to DSAEK failure. Patients had been treated at the Bascom Palmer Eye Institute and University of Miami Veterans Hospital between October 2015 and March 2020. Researchers performed histopathological analysis on 3 mechanisms proposed for retrocorneal membrane formation, including epithelial downgrowth, keratocyte ingrowth, and fibrous metaplasia of the corneal endothelium.

Researchers revealed there were 7 participants with clinically significant retrocorneal membranes that led to DSAEK graft failure (3 men and 4 women). The average age at the time of initial DSAEK was 70 years (range 55-85). All patients were pseudophakic at the time of initial DSAEK and had a history of glaucoma and glaucoma drainage device surgery. 

At 0 to 47 months after DSAEK surgery, participants experienced graft failure caused by proliferated retrocorneal fibrous membrane. After graft failure, 4 patients had penetrating keratoplasty, and 3 had repeat DSAEK. In all cases, histopathologic evaluation identified a pigmented fibrocellular tissue along the posterior margin of the corneas and DSAEK buttons. Further characterization using immunohistochemistry and immunofluorescence revealed all membranes were negative for pancytokeratin and positive for α-SMA, vimentin, N-cadherin, ZEB1, Snail, ROCK1, and RhoA.

Limitations of this study include a limited number of cases and defined histopathological markers. 

The study researchers concluded that in patients with previous glaucoma drainage device surgery, fibrocellular retrocorneal membrane proliferation may be linked to DSAEK failure and may have possible endothelial origin.


Naranjo A, Pirakitikulr N, Pelaez D, et al. Clinicopathologic correlations of retrocorneal membranes associated with endothelial corneal graft failure [published online August 15, 2020]. Am J Ophthalmol. doi: 10.1016/j.ajo.2020.08.016