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The challenge of graft repositioning for graft dislocation after DSAEK in a patient with previous trabeculectomy

Poster Details

First Author: F.Segev ISRAEL

Co Author(s):    A. Belkin   R. Nesher           

Abstract Details



Purpose:

Endothelial keratoplasty has become the standard of care for corneal endothelial dysfunction. In recent publications previous glaucoma surgery was associated with a significantly increased rate of graft dislocation compared with eyes which did not undergo a prior glaucoma surgery. We aimed to describe a patient with a prior trabeculectomy surgery who underwent DescemetÂ’s stripping automated endothelial keratoplasty (DSAEK). The patient had graft dislocation and underwent graft repositioning twice.

Setting:

Department of Ophthalmology, Meir General Hospital

Methods:

We describe herein a 60 year old glaucoma patient with pseudophakic bullous keratopathy who underwent uneventful DSAEK

Results:

No intraoperative complications were seen. One day post-operatively graft dislocation was noted associated with normal intraoperative pressure. The graft was repositioned and rebubbled successfully, but on postoperative day 2 it was dislocated again. On slit lamp examination air bubbles were noted in the filtering bleb site. Thus, immediately after a second graft repositioning the patient was put in a supine Trandelenburg position. Few hours later the graft was adherent and well-centered.

Conclusions:

Previous trabeculectomy is associated with a significantly increased rate of graft dislocation. Trandelenburg positioning may prevent air escape to bleb site and decrease graft dislocation rate in patients with prior trabeculectomy/ glaucoma drainage device surgery.

Financial Disclosure:

NONE

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