Posterior Dislocation of Descemet Stripping Automated Endothelial Keratoplasty Graft Can Lead to Retinal Detachment

Department of Surgery, Section of Ophthalmology and Visual Science, University of Chicago, Chicago, IL, USA.
Cornea (Impact Factor: 2.36). 11/2010; 29(11):1284-6. DOI: 10.1097/ICO.0b013e3181e84402
Source: PubMed

ABSTRACT To describe traction retinal detachment as a complication of posterior dislocation of Descemet stripping automated endothelial keratoplasty (DSAEK) graft.
Vitrectomy surgery was performed in 3 eyes that developed posterior dislocation of DSAEK graft. Intraoperatively, the corneal tissue was found to be adherent to the retina. In 2 cases, a retinal detachment with proliferative vitreoretinopathy (PVR) was already present and the donor DSAEK flap was found to be fused with the retina. In 1 case, the retina was attached at the time of surgery but PVR subsequently developed despite near total removal of the graft, requiring an additional procedure to achieve retinal reattachment.
Corneal tissue removal with a vitreous cutter was attempted in all cases. Residual tissue that had fused with the retina was left in place. Retinal reattachment was achieved with silicone oil injection in 2 cases and scleral buckle alone in 1 case.
Posterior segment dislocation of a DSAEK flap and its adherence to the retina may cause PVR and traction retinal detachment. Early removal is warranted when dislocation occurs.

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    • "Owing to the risks of further complications arising from the posteriorly dislocated grafts, such as retinal detachment [8], cystoid macular oedema, and epiretinal membrane formation , the dislocated grafts in all previously reported cases were retrieved either in the same operation or later by either a standard three-port vitrectomy or an anterior approach with irrigation and aspiration through the corneal wound. "
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    ABSTRACT: To report a case of intraoperative graft dislocation into the vitreous cavity during Descemet stripping automated endothelial keratoplasty (DSAEK) in an aniridic eye despite the presence of an iris prosthetic lens, and the surgical technique for immediate rescue of the donor lenticule. A 30-year-old man, who had undergone previous pars plana vitrectomy, penetrating keratoplasty, and iris prosthetic lens implantation (Morcher Aniridia Implants 67G) for traumatic aniridia, underwent DSAEK for failed penetrating keratoplasty. Intraoperatively, the graft dislocated into the posterior segment through the gap between the lens implant and the scleral wall. The dislocated graft was grasped with a 23-gauge vitrectomy forceps inserted through the temporal scleral incision and the implant-scleral wall gap. The straight endoglide insertion forceps was then introduced through a nasal paracentesis and used to pull the donor from the posterior segment into the anterior chamber through the implant-scleral wall gap. Postoperatively, the patient did well with no evidence of graft dislocation or retinal detachment, and rapid clearing of the donor and recipient cornea. Donor endothelial cell loss was only 11% at 6 months after DSAEK. Graft dislocation into the vitreous cavity can occur during DSAEK, even in the presence of a large iris prosthetic lens implant. In a previously vitrectomized eye, immediate retrieval of the donor from the retina can be performed using a vitrectomy forceps inserted through the existing temporal scleral DSAEK incision into the posterior segment, thus obviating the need for further pars plana incisions.
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