Interface Fluid After Uneventful Dsaek: The Role Of Intraoperative Oct

To report an interesting case of interface fluid after uneventful Descemet Stripping Automated Endothelial Keratoplasty and highlight the role of intraoperative Optical Coherence Tomography in the detection of similar cases.

2^nd Department of Ophthalmology, Aristotle University of Thessaloniki, Papageorgiou General Hospital, Thessaloniki, Greece

A 68-year-old female suffering from pseudophakic bullous keratopathy in her right eye (BCVA=20/400) underwent uneventful DSAEK. During surgery, the intraoperative OCT depicted a slight accumulation of fluid in the central interface between the host and graft, which did not resolve completely after a full anterior chamber fill with air and subsequent massaging on the corneal surface. On the first 2 postoperative days, the central interface fluid remained stable in OCT examination, while the peripheral graft was 360° attached. Five days after surgery the patient reported a further decrease in her vision and the examination revealed a complete detachment and dislocation of the graft in the inferior anterior chamber. The graft was surgically repositioned on the same day and kept in place with an 80% anterior chamber fill with air. Upon rebubbling, no interface fluid was noted in the intraoperative OCT. The graft remained attached with an uneventful postoperative course and her BCVA increased to 20/100 and 20/30, 1 week and 3 months after surgery, without any other adverse events.

Intraoperative OCT is a useful tool for detecting interface fluid and other complications during endothelial keratoplasty. Its application could reduce the rate of graft detachment and the need for further interventions, which could jeopardize the viability of the graft.