Descemet stripping automated endothelial keratoplasty graft in-the-bag posterior dislocation.

Abstract

To describe a case of a dislocated Descemet stripping automated endothelial keratoplasty (DSAEK) graft retained in-the-bag removed with pars plana vitrectomy (PPV). Case report. A 69- year-old pseudophakic male who underwent a repeat DSAEK due to bullous keratopathy in the setting of multiple previous ocular surgeries presented with a vision of counting fingers. Upon examination a DSAEK graft was appreciated behind the intraocular lens obscuring the visual axis and presumed to be in the anterior vitreous. The patient underwent a 23-gauge vitrectomy and after a posterior capsulotomy, the dislocated graft was removed with a 23-gauge vitrector without complications. Best corrected visual acuity was 20/50 six months after the PPV. Grafts can dislocate posteriorly between the intraocular lens and the posterior capsule. The dislocated graft can be successfully extricated with a 23-gauge vitrector after a careful posterior capsulotomy, with good visual outcomes. To our knowledge, this is the first reported case of an in-the-bag DSAEK graft posterior dislocation. Furthermore, we showed an innovative surgical technique for the removal of the dislocated graft with a 23-gauge vitrectomy and posterior capsulotomy.