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JAMA Ophthalmology Clinical Challenge
August 8, 2019

Interface Haze After Descemet Stripping Automated Endothelial Keratoplasty

Author Affiliations
  • 1Division of Clinical Neuroscience, Academic Ophthalmology, School of Medicine, University of Nottingham, Nottingham, United Kingdom
  • 2Department of Ophthalmology, Queen Medical Centre, Nottingham, United Kingdom
JAMA Ophthalmol. Published online August 8, 2019. doi:10.1001/jamaophthalmol.2019.2745

A 79-year-old woman presented to the eye emergency department with a 2-day history of right eye pain and photophobia. She had undergone an uncomplicated Descemet stripping automated endothelial keratoplasty (DSAEK) for Fuchs endothelial dystrophy in the right eye 5 months before, which improved her corrected-distance visual acuity to 20/20 OD. She denied any history of ocular trauma or cold sores, and she was taking dexamethasone, 0.1% drops 4 times a day.

At presentation, her corrected-distance visual acuity was 20/60 OD. Slitlamp examination revealed a right inflamed conjunctiva with circumcorneal hyperemia, 2 mm × 2 mm epithelial defect with a small infiltrate at the temporal cornea, 2+ cells in the anterior chamber with a 1-mm hypopyon, and a peculiar graft-host interface haze with crisscross pattern (Figure, A). Corneal scrapes were performed and samples were sent for microscopy with Gram staining, culture, and sensitivity testing. The patient was admitted on that day and commenced taking topical cefuroxime, 5%, and gentamicin, 1.5%, drops every hour around the clock, and topical steroid was discontinued. One day later, there was no improvement in the graft-host interface haze, and results of microbiological investigations, including donor rim culture, were all negative. In view of the clinical dilemma, an in vivo confocal microscopy was performed to aid the diagnosis (Figure, B).