Posterior Dislocation and Immediate Retrieval of a Descemet Stripping Automated Endothelial Keratoplasty Graft

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.