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Management of an upside down graft of a Descemet's stripping automated endothelial keratoplasty in an eye with�Â� iridocorneal�Â� endothelial�Â� syndrome and previous graft failure

Poster Details

First Author: F.Luengo Gimeno ARGENTINA

Co Author(s):    F. Arasanz                    

Abstract Details


To describe the management and complications of a flipped over lenticule of a Descemet stripping automated endothelial keratoplasty (DSAEK) in an eye with�Â� iridocorneal�Â� endothelial�Â� syndrome (ICE), glaucoma, trabeculectomy and previous graft failure.


Arasanz Laser Vision, Buenos Aires, Argentina.


A 50-year-old woman with�Â� ICE, pseudophakic glaucoma, trabeculectomy and previous failed DSAEK underwent on a second DSAEK in her right eye. The new lenticule injected with the Tan Endoglide flipped over and the endothelial face could not be identified. It was attached to the recipient stroma with a 10mm air bubble. On the second day the graft was detached. The upside-down lenticule was removed. A third DSAEK was performed without complications. The main outcome measures were intraoperative lenticule pachymetry, BSCVA, intraocular pressure and endothelial cell loss at 7, 30 and 6 months. Rebubbling rate and graft failure were recorded.


Iris-corneal synechiae, removed without bleeding, were present in all previous corneal incisions. A superior Sipeser slipknot iris suture resolved the corectopia. A complete air fill of the AC could only be managed after multiple attempts due to escape of air to the posterior chamber. The second lenticule of 90um flipped over inside the TAN endoglide. A Third DSAEK was done without complications. The postopterative BSCVA was 20/30. The IOP was between 8 and 15 during all the follow up. No rebubbling, graft dislocation or failure was recorded. At last follow up, the endothelial cell loss was 20%.


In the presented case, the third DSAEK was effective in the treatment of a 2 previous DSAEK graft failure. Management of DSAEK in an eye with�Â� iridocorneal�Â� endothelial�Â� syndrome is challenging. It requires a correct instrumentation of the technique and precise manipulation of the abnormal iris.

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