Multiplanar AS-OCT Detection of Clinically Occult Posterior Gas Bubble Dislocation After DSAEK

Area of Science:

• Ophthalmology
• Corneal Surgery
• Ophthalmic Imaging

Background:

• Descemet stripping automated endothelial keratoplasty (DSAEK) relies on intracameral gas tamponade for graft adherence.
• Endothelial dysfunction, such as Fuchs endothelial corneal dystrophy, necessitates advanced surgical interventions like DSAEK.
• Postoperative complications, including those related to gas tamponade, can impact graft success and visual outcomes.

Purpose of the Study:

• To report a case of clinically occult posterior gas migration after DSAEK.
• To highlight the diagnostic utility of multiplanar anterior segment optical coherence tomography (AS-OCT) in detecting subtle gas abnormalities.
• To emphasize the importance of timely intervention for potentially sight-threatening complications following DSAEK.

Main Methods:

• A 67-year-old female with Fuchs endothelial corneal dystrophy underwent DSAEK with sulfur hexafluoride (SF6) gas tamponade.
• Postoperative assessment included slit-lamp examination and detailed multiplanar AS-OCT (vertical, horizontal, rotational scans).
• Surgical re-intervention was performed due to detected gas migration and altered anterior segment anatomy.

Main Results:

• Slit-lamp examination initially suggested satisfactory graft attachment.
• Multiplanar AS-OCT revealed subtle posterior gas bubble migration beneath the iris, not apparent on slit-lamp examination.
• Prompt surgical decompression and repositioning of the gas tamponade restored normal anterior chamber configuration and ensured stable graft adherence.
• Best-corrected visual acuity improved significantly from 0.1 preoperatively to 0.7 at 2 weeks post-intervention.

Conclusions:

• Multiplanar AS-OCT is crucial for detecting clinically occult posterior gas migration after DSAEK, especially when findings are scan-orientation-dependent.
• Early identification of gas migration via AS-OCT facilitates timely surgical intervention, preventing complications like secondary angle-closure or malignant glaucoma.
• This case underscores the value of advanced imaging in optimizing DSAEK outcomes and patient visual recovery.