A 77-year-old woman with a history of glaucoma and multiple surgical procedures complained of decreasing vision due to corneal edema. Preoperative visual acuity was light perception in the affected eye. She underwent corneal transplantation using Descemet’s stripping automated endothelial keratoplasty (DSAEK).
Slit-lamp photography demonstrated folded DSAEK donor tissue that had detached from the stroma. The graft was displaced posteriorly, resting between the iris and an IOL implant. This was the second attempt at a DSAEK procedure in the patient. Published reports suggest a 4 to 35 percent dislocation rate after DSAEK, although recent surgical advances are reducing the risk. Factors contributing to DSAEK failure or detachment include peripheral anterior synechiae, shallow anterior chamber and/or previous glaucoma filter or tube-shunt procedures. Despite a number of high-risk characteristics, this particular patient underwent a successful DSAEK procedure on the third attempt, improving her vision to counting fingers.
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