Management of detached graft donor by SF6 injection following Descemet stripping automated endothelial keratoplasty of an eye with iridocorneal endothelial syndrome and Ahmed glaucoma drainage tube

Abstract

A 65-year-old woman with iridocorneal endothelial syndrome and a history of Ahmed glaucoma drainage (AGD) tube implantation underwent Descemet stripping automated endothelial keratoplasty (DSAEK) in her right eye. During the procedure, filling the anterior chamber with air was quite difficult due to escape of air via the AGD tube and a complete air fill of the anterior chamber could only be managed after multiple attempts. On operation night, there was no air left in the anterior chamber. On postoperative day 1, graft detachment was determined by slit-lamp biomicroscopy. For rebubbling, sulfur hexafluoride (SF(6)) 20 % was injected into the anterior chamber. Two days later, there was still some SF(6) in the anterior chamber and the graft was completely attached. At postoperative week 2, visual acuity was 2/10. SF(6) use may be considered for DSAEK in cases of previous AGD tube implantation history due to its potential for longer duration in order to obtain a better tamponade with the bubble due to its expanding nature.