A Novel Approach to Processing Descemet Stripping Automated Endothelial Keratoplasty Specimens for Histopathologic Analysis

Purpose: To describe a new technique for handling Descemet stripping automated endothelial keratoplasty (DSAEK) specimens intraoperatively and during processing. Methods: The processing method begins by adding a drop of eosin to the specimen intraoperatively, followed by submersion in 10% formalin solution. The specimen appears reddish, allowing for easy identification and is floated onto an immersed slide to maintain an unfolded flattened specimen. After bisection, one half is stained with hematoxylin and eosin and covered with a cover slip, whereas the other half is transferred to filter paper and a cassette and is submitted for paraffin embedding on the cut edge. Results: The technique reduces the chances of a specimen not surviving processing. The new method also allows for 2 views of DSAEK specimens, both topographical and cross-sectional, thus permitting analysis of endothelial cell density, spatial distribution of cells and guttae, endothelial cell count, and thickness measurements. Conclusions: A novel technique for handling DSAEK specimens to prevent loss and folding, while also allowing for cross-sectional and topographical viewing is reported.