Deep sclerectomy after DSAEK: A cautionary tale

A 78-year-old pseudophakic women with pseudoexfoliation glaucoma and 6-year history of prior Descemet's stripping automated endothelial keratoplasty (DSAEK) underwent deep sclerectomy for a poorly controlled glaucoma. Exposure of the trabeculo-Descemet's window (TDW), showed a very poor drainage. An attempt to dissect the fibrous tissue off the TDW resulted in perforation of the window needing peripheral iridectomy, followed by a white fibrous band which had to be excised to prevent blockade of the filtration channel. Postoperatively, there was complete detachment of the endothelial graft on day 1 with an intraocular pressure of 20 mm Hg. She was commenced on topical steroids and listed for a revisionary DSAEK in 6 weeks but when reviewed in a month postoperatively, a spontaneous reattachment of the endothelial graft was seen.