Reattachment of a posteriorly dislocated graft in Descemet's stripping automated endothelial keratoplasty

A man in his early 70s underwent Descemet's stripping automated endothelial keratoplasty (DSAEK) for endothelial decompensation. During surgery, the DSAEK lenticule dislocated into the vitreous cavity due to the patient's aphakia and aniridia from a complex cataract operation. After 26 hours, the graft was retrieved, a scleral fixated intraocular lens was implanted and the same dislocated donor lenticule was reattached. Identifying graft orientation was aided by lenticule curvature, Descemet's membrane folds, stromal striations and gentian violet markings. A 6-month follow-up revealed functional endothelial cells and improved visual acuity. This case elaborates a technique to retrieve a posteriorly dislocated lenticule ensuring minimal damage to the endothelium, details tips for identifying the correct orientation of the lenticule after retrieval and describes graft survival chances after reattachment of the same dislocated lenticule.