Prone positioning may promote graft adherence after DSAEK

This is an interesting report on a case of donor graft dislocation after Descemet stripping automated endothelial keratoplasty (DSAEK) that resolved spontaneously after face-down positioning.

The patient was a 75-year-old woman with Fuchs’ dystrophy who underwent repeated endothelial graft detachments after simultaneous DSAEK and phacoemulsification. She underwent multiple intraoperative and postoperative attempts to attach the donor button, including the use of new donor tissue, placement of air into the anterior chamber and postoperative face-up positioning.

However, one month after the second donor tissue placement, she had a free-floating donor graft in the anterior chamber. She was subsequently instructed to remain in the prone position for several hours a day for two days. This resulted in spontaneous graft attachment and a rapid improvement to a BCVA of 20/50 three weeks after the prone positioning and 20/25 at postoperative month nine.

Given the authors’ experience, corneal surgeons may consider this type of conservative approach in the case of DSAEK donor tissue dislocation prior to advancing to full-thickness penetrating keratoplasty.