Anterior Segment Optical Coherence Tomography Helped In The Management Of A Curious Double Chamber After Descemet Stripping With Automated Endothelial Keratoplasty

Published 2022 - 40th Congress of the ESCRS

Reference: PO043 | Type: Case report | DOI: 10.82333/n7q3-5t05

Authors: Sofía del-Pozo-Lérida* ¹ , Alexandra Arango ² , Consuelo Arnaldos-López ¹ , Júlia Pintos-Widmer ¹

¹Hospital General de Granollers,Barcelona,Spain, ²Hospital Germans Trias i Pujol,Barcelona,Spain

To highlight the importance of the anterior segment optical coherence tomography (AS-OCT) imaging in the follow-up of corneal transplantation, as well as its usefulness to solve complications that may appear.

The number of lamellar keratoplasties is rising notably over the last years. When dislocations occur, reattachment of the graft is often achieved by injecting air in the anterior chamber, with the so-called rebubbling technique. However, this approach is not always successful, especially if any posterior corneal surface irregularity exists. This is where the AS-OCT plays an important role.

A 88 years old male patient, with a history of advanced glaucoma intervened with trabeculectomy in both eyes, presented with a central corneal ulcer of chronic aspect and aphakia in his left eye. No previous historical record was available. He was offered a DSAEK and an Artisan implant in order to achieve pain relieve (not so much to gain visual acuity), which he accepted.

In the first postoperative day, a double chamber could be seen inferonasally, and the remaining air bubble occupied 30% the anterior chamber. Rebubbling was performed to reattach the graft. An AS-OCT was performed. It revealed that a fold between the graft and the recipient cornea was responsible for the graft detachment. The fold appeared to be a Descemet membrane rest, possibly from the descemetorhexis.

In a second surgery, the graft was displaced superiorly, and the posterior stroma of the recipient cornea was carefully cleaned to remove all possible remanents between the two surfaces. Additionally, the decision to place 3 transfixing sutures was made to reassure the correct placement of the graft.

The first day postoperatively, graft was attached. In the SA-OCT the graft could be seen in place, and the Descemet fold outside the graft, attached to the rest of the patient’s Descemet.

Dislocation of the graft is a common complication of the DSAEK technique.Most of the cases can be solved with the rebubbling technique. However,if there is an irregularity of the posterior recipient surface,this technique will be ineffective.

The AS-OCT obtains high-resolution cross-sectional images of the cornea and anterior chamber. Its use was key to reveal a misplaced Descemet fold between the graft and the recipient cornea,which allowed a more guided approach to solve the displacement of the graft.

This case highlights the great utility of the AS-OCT in the follow-up and management of corneal transplantations in order to achieve a greater overview of the situation in front of a complication, helping to achieve a better surgical outcome.