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Deep sclerectomy after DSAEK: A cautionary tale.
1Ophthalmology, Royal Liverpool and Broadgreen Hospitals NHS Trust, Liverpool, UK aysha.salam320@gmail.com.
BMJ Case Reports
|June 16, 2021
Summary
A glaucoma patient with a prior endothelial keratoplasty experienced graft detachment after surgery. Spontaneous reattachment occurred within a month, highlighting the potential for graft survival despite complications.
Area of Science:
- Ophthalmology
- Glaucoma Surgery
- Corneal Transplantation
Background:
- A 78-year-old pseudophakic female with pseudoexfoliation glaucoma and a history of Descemet's stripping automated endothelial keratoplasty (DSAEK) presented with poorly controlled glaucoma.
- The patient underwent deep sclerectomy, a surgical procedure to improve aqueous humor outflow.
Observation:
- Intraoperative findings revealed poor drainage through the trabeculo-Descemet's window (TDW).
- Attempts to clear fibrous tissue from the TDW led to perforation, requiring peripheral iridectomy and excision of a fibrous band obstructing the filtration channel.
Findings:
- Postoperatively, complete endothelial graft detachment was observed on day 1, with an intraocular pressure of 20 mmHg.
- Despite initial graft failure and plans for revisionary DSAEK, spontaneous reattachment of the endothelial graft occurred by the one-month postoperative follow-up.
Implications:
- This case suggests that spontaneous endothelial graft reattachment is possible even after significant surgical complications and graft detachment.
- The findings may inform management strategies for endothelial graft complications following glaucoma surgery.
