Download PDF

Make your diagnosis in the comments, and look for the answer in next month’s Blink.

Last Month’s Blink

Additional DSEK Graft Placement for a Failed PK

Written by Karen M. Wai, BA, Case Western Reserve University, and Rony R. Sayegh, MD, University Hospitals Eye Institute. Photo by Rony R. Sayegh, MD, University Hospitals Eye Institute. All are in Cleveland.

A 91-year-old man with Fuchs dystrophy was referred to our institution for a failed Descemet stripping endothelial kerato­plasty (DSEK) graft in his left eye. He had also previously undergone penetrating keratoplasty (PK) in his left eye.

After examining and consulting with the patient, we made plans to attempt a repeat DSEK. However, given the similar diameters of the preex­isting DSEK and PK grafts at the time of surgery, there were concerns for internal dehiscence at the graft-host junction. As a result, a second DSEK corneal button was inserted without removal of the failed DSEK graft.

Deturgescence of the grafts and increasing clarity of the cornea were noted with follow-up six months after surgery. The three grafts (denoted by * for PK, + for the initial DSEK, and # for second DSEK) are pictured on biomicroscopy (Fig. 1) and optical coherence tomography (Fig. 2).

Read your colleagues’ discussion.