Purpose: To report a case of progressive fibrotic contraction of the posterior lamellar graft after initially successful Descemet’s stripping automated endothelial keratoplasty (DSAEK). Methods: Retrospective report of clinical data and histopathological analysis of excised corneal tissue. Results: A 63-year-old woman underwent uncomplicated DSAEK in her left eye due to endothelial dystrophy. During the first months after surgery, her visual acuity was 0.3, and a semilunar contraction gradually appeared at the edge of the graft. Over the following months, the fibrotic changes progressed and visual acuity decreased, with no improvement after uncomplicated cataract surgery. A successful penetrating keratoplasty was performed, and the excised corneal button with an attached posterior lamellar graft was histologically examined. The affected part of the graft consisted of a thickened fibrocellular tissue positive for glycosaminoglycans and smooth muscle actin. Conclusions: The present case demonstrates asymmetric fibrotic contraction of a DSAEK graft.

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