Intracellular dark spots are associated with endothelial cell loss after Descemet's stripping automated endothelial keratoplasty.

Intracellular dark endothelial spots (IDESs) on specular microscopy developed in 78/122 patients (63.9%) after Descemet stripping automated endothelial keratoplasty (DSAEK). Endothelial cell density (ECD) after DSAEK was significantly smaller in eyes with IDES when compared with those without at all time points (p<0.001) despite no significant difference in graft ECD (p=0.43), resulting in an increased rate of endothelial failure (p=0.044). The presence of glaucoma (OR=2.22, p=0.027), iris damage (OR=2.85, p=0.004) and non-Fuchs status (OR=2.37, p=0.018) were identified as risk factors for IDES development. Preoperative total protein level in aqueous humour was significantly higher in eye with endothelial failure than those without (p=0.0057).