A Cause of Reticular Interface Haze and its Management After Descemet Stripping Endothelial Keratoplasty

Purpose: To describe a cause and management of interface haze after Descemet stripping endothelial keratoplasty (DSEK). Methods: Five patients underwent uncomplicated combined DSEK/phacoemulsification with intraocular lens implantation at a tertiary referral center over a span of 3 months. In each case, the recipient Descemet membrane was stripped with the anterior chamber filled with a cohesive viscoelastic. Patients subsequently developed visually significant haze in the graft-host interface that had a fine reticular pattern. Examination also revealed a small separation between the donor and recipient cornea in 3 cases. In all cases, there was no communication between the area of detachment and the anterior chamber, and the overlying recipient cornea was clear. Clinical and imaging findings of the interface haze suggested that it was the result of retained viscoelastic in the interface. Patients were either observed or underwent surgery to irrigate the viscoelastic from the interface. Results: Of the 5 patients, 3 were simply observed with eventual clearing of the haze and attainment of best-corrected visual acuity of 20/40 or better. Two patients with more extensive interface haze and visible space on slit examination between the donor and recipient cornea underwent irrigation and aspiration of the graft-host interface, with quick resolution of the haze. All grafts remained clear at the last follow-up. Conclusions: Retained viscoelastic at the graft-host interface during DSEK can cause a reticular interface haze that can compromise visual clarity. The haze can be eliminated by irrigating and aspirating the graft-host interface with improvement in vision. Careful irrigation and aspiration of viscoelastic from the posterior corneal surface of the recipient at the time of endothelial keratoplasty can prevent this form of interface haze.