Abstract
Purpose: :
To report three cases of spontaneous donor lenticle reattachment in patients who have undergone Descemet Stripping Automated Endothelial Keratoplasty (DSAEK).
Methods: :
All DSAEK’s performed between November 2007 and May 2008 by IJU and RW were reviewed. Any cases which had complete donor lenticle detachment at postoperative day one were noted. Those cases which spontaneously reattached without having to be rebubbled were reviewed.
Results: :
The first patient was a 71 year old female with a past ocular history significant for Fuch’s dystrophy status post combined penetrating keratoplasty and cataract extraction in her left eye in 2000. In November 2007, the patient represented with a failed PK OS and medication-controlled open angle glaucoma. The patient subsequently underwent DSAEK. On post operative day#1 visual acuity was Counting Fingers at 1 foot. She had a complete detachment of her DSAEK lenticle, but the graft was noted to be well centered. The intraocular pressure was 43, which was controlled with topical medications. On post-operative day#5 best corrected visual acuity was 20/200, intraocular pressure was 10 and the lenticle was completely attached.The 2nd patient was an 83 year old male with chronic open angle glaucoma and pseudophakic bullous keratopathy OD. The patient underwent DSAEK OD. On postoperative day#1 his visual acuity was Counting Fingers. Hypotony and a complete detachment of a well-centered graft were noted. On post operative day #11, 1 day prior to being brought back to the operating room for a refloat, the patient noted spontaneous improvement of his vision. Examination at the slit lamp revealed that the lenticle had spontaneously reattached.The 3rd patient was an 83 year old woman with a history of pseudophakic bullous keratopathy and topically-controlled glaucoma OS who underwent DSAEK. On postoperative day 1 a complete detachment of her DSAEK lenticle was noted with Hand Motions vision. On postoperative day 5, the patient noted spontaneous improvement in her vision. Her graft was noted to be slightly decentered, but reattached with a small amount of interface fluid. Her vision was 20/400. Over the next 3 weeks, the interface resolved and her vision improved to 20/40 over time.
Conclusions: :
Spontaneous reattachments of DSAEK lenticles is possible as far out as 11 days postoperatively. Surgeons performing DSAEK may want to delay rebubbling in selected cases.
Keywords: transplantation • wound healing