Posterior Dislocation of Descemet Stripping Automated Endothelial Keratoplasty Graft Can Lead to Retinal Detachment
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.
- SourceAvailable from: Ka Wai Kam
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- "Owing to the risks of further complications arising from the posteriorly dislocated grafts, such as retinal detachment , 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. "
ABSTRACT: A thirty-year-old Chinese man with a history of severe trauma to his right eye, with secondary sectoral aniridia and multiple operations including intraocular lens insertion more than fifteen years ago, underwent an uneventful Descemet's Stripping Automated Endothelial Keratoplasty (DSAEK) for his pseudophakic bullous keratopathy in a tertiary hospital in Hong Kong. The nature of his previous operations was unknown to the surgeon at the time of transplant. On postoperative day one, the graft was not present in the anterior chamber. Fundal view was limited because of corneal oedema. B-scan ultrasonography could not detect any definite presence of a donor button in the posterior segment as gas was present in the vitreous cavity. The patient was instructed to lie prone full time, and on postoperative day three, the graft was found to be reattached to the stroma with spontaneous resolution of corneal oedema, indicating restoration of pump function of endothelium graft. This is the first case of spontaneous reattachment of a posteriorly dislocated endothelial graft without surgical intervention or abandonment of the grafted endothelial button.03/2013; 2013:631702. DOI:10.1155/2013/631702
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ABSTRACT: To report a series of dislocations of the donor graft into the posterior segment associated with Descemet stripping endothelial keratoplasty (DSAEK) and to identify possible risk factors for dislocation and clinical outcomes. Retrospective case series. Cases of donor graft dislocation into the posterior segment associated with endothelial keratoplasty were identified from the clinical experience of 7 surgeons. Observations included the preoperative surgical history of each eye, preoperative and postoperative visual acuity, management of the complication, and the postoperative clinical course. No identified cases were excluded from this series. Eight posterior graft dislocations were associated with DSAEK surgery. Each eye had a history of vitrectomy. Five eyes had sutured posterior chamber intraocular lenses, 1 eye had a sulcus intraocular lens, and 2 eyes were aphakic. Each eye required repeat grafting, and in 6 of 8 eyes, pars plana vitrectomy was used to remove the dislocated graft. Final visual acuities ranged from 20/30 to no light perception. Graft dislocation into the posterior segment is a rare complication of DSAEK surgery that can lead to permanent vision loss. It has occurred in eyes that have undergone previous vitrectomy and complicated intraocular lens placement or were aphakic. As is the case with a dropped lens nucleus during cataract extraction, visual acuities after a dropped DSAEK graft range from very good to no light perception. Better postoperative results seem to be associated with prompt removal of the posteriorly dislocated graft.American Journal of Ophthalmology 11/2011; 153(4):638-42, 642.e1-2. DOI:10.1016/j.ajo.2011.09.006 · 4.02 Impact Factor
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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.Cornea 01/2012; 31(4):450-3. DOI:10.1097/ICO.0b013e31823f76d5 · 2.36 Impact Factor