Dislocation of the Donor Graft to the Posterior Segment in Descemet Stripping Automated Endothelial Keratoplasty

Purpose 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. Design Retrospective case series. Methods Cases of donor graft dis...

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Bibliographic Details
Published in:American journal of ophthalmology 2012-04, Vol.153 (4), p.638-642.e2
Main Authors: Afshari, Natalie A, Gorovoy, Mark S, Yoo, Sonia H, Kim, Terry, Carlson, Alan N, Rosenwasser, George O.D, Griffin, Neil B, McCuen, Brooks W, Toth, Cynthia A, Price, Francis W, Price, Marianne, Fernandez, Mark M
Format: Article
Language:English
Subjects:
Aged
Biological and medical sciences
Descemet Stripping Endothelial Keratoplasty - adverse effects
Endothelium, Corneal - pathology
Female
Graft Rejection - etiology
Humans
Male
Medical sciences
Miscellaneous
Ophthalmology
Posterior Eye Segment - pathology
Reoperation
Retrospective Studies
Risk Factors
Tissue Donors
Treatment Outcome
Visual Acuity - physiology
Vitrectomy
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Summary:Purpose 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. Design Retrospective case series. Methods 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. Results 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. Conclusions 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.
ISSN:0002-9394
1879-1891
DOI:10.1016/j.ajo.2011.09.006