*Correspondence – Arthur Hammer: a.hammer@nhs.net

Purpose We describe 2 cases who underwent uneventful DMEK surgery but presented delayed recovery and had confirmed cornea guttata in the donor tissues. Both patients received a cornea from the same donor.

Cases A 78-year-old man with Fuchs’ dystrophy underwent triple procedure (phaco + IOL + DMEK) in his right eye and presented persistent central corneal oedema despite fully attached graft. Early rejection was suspected, and the oedema took 6 weeks to resolve completely at which point we confirmed central guttata in the donor tissue. His contralateral eye underwent DMEK surgery six months before and had clear cornea with no guttata. A 74-year-old man with corneal scarring and aphakic bullous keratopathy underwent DMEK surgery and had a persistent corneal oedema postoperatively even after initial rebubbling for a partially peripherally detached graft. Corneal oedema persisted for two months postoperatively despite full attachment and guttata identified. Both donor corneas were reported to have endothelial cell counts of 2600 cells/mm² preoperatively. In both cases confocal microscopy confirmed the presence of guttata in the donor graft. An imaging assessment from the donor tissues was performed with the eye bank and review from the literature is discussed.

Conclusion Fuchs’ dystrophy appears relatively common in the general population (4% in the USA); thus, a proportion of this condition might be expected in donor corneas. Identification of guttae in donor corneas with early stages of Fuchs’ dystrophy appears challenging. Current modalities of graft material screening (which appears to be standardised across Europe) are more orientated toward measuring the endothelial cell density and morphology and less toward detection of guttae. However, we believe this challenging case may not be isolated and thus improvement of eye bank screening would be of critical value to detect early Fuchs’ dystrophy in donor tissues and therefore improve graft survival.