Prone Positioning to Facilitate Graft Adherence in the Late Postoperative Period After Descemet Stripping Automated Endothelial Keratoplasty

Abstract

The aim of this study was to report the use of prone positioning to facilitate graft adherence in the late postoperative period after Descemet stripping automated endothelial keratoplasty (DSAEK). A 75-year-old woman with Fuchs dystrophy had repeated endothelial graft detachments after simultaneous DSAEK and phacoemulsification cataract surgery. Multiple attempts in the operating room to reposition the tissue, including placement of air into the anterior chamber, postoperative face-up positioning, and the use of new donor tissue, were unsuccessful. In the late postoperative period, the patient was placed in a prone (face-down) position at home to promote graft adherence. After the maneuver, the endothelial graft was well attached, although it was slightly decentered. The remainder of the patient's postoperative course was routine, and her best-corrected visual acuity is 20/25 with a clear cornea 9 months later. Prone positioning can be used as a conservative maneuver to promote graft adherence after DSAEK when there is difficulty in achieving attachment postoperatively, especially when a return trip to the operating room may not be practical.