Complete Spontaneous Reattachment After Early Dsaek Detachment In A Mechanically Non-Mobile Eye

To describe a documented case of spontaneous complete Descemet stripping automated endothelial keratoplasty (DSAEK) graft reattachment after early postoperative detachment in a severely non-mobile, vitrectomized eye with complex anterior segment anatomy, and to reconsider the role of immediate re-intervention in selected cases.

Cornea & Ocular Surface Unit, Department of Ophthalmology, Hospital Universitario la Princesa, a tertiary center, Madrid, Spain.

A 74-year-old functionally monocular patient underwent DSAEK in the right eye for secondary endothelial decompensation with chronic corneal edema and visual decline. The eye had a complex surgical history, including retinal detachment repair with residual scleral buckle elements and pars plana vitrectomy, followed by intraocular lens exchange and implantation of a prepupillary iris-claw anterior chamber intraocular lens. Orbital imaging and clinical findings were consistent with conjunctivo-orbital fibrosis and residual buckle material causing severe mechanical ophthalmoplegia and a practically fixed globe with minimal residual ocular micro-movements.

On postoperative day 1, anterior segment optical coherence tomography (AS-OCT) demonstrated partial graft detachment with some peripheral contact. On day 2, rebubbling with 20% SF6 was performed. The following day, slit-lamp examination showed no visible gas bubble, and AS-OCT confirmed persistent detachment with limited contact at the superior and inferior edges. Intraocular pressure was low, and the eye was considered at high risk of graft failure. Conservative management with strict supine positioning and topical corticosteroids was maintained. Five days after rebubbling, AS-OCT demonstrated complete graft reattachment with reduced corneal thickness. Follow-up confirmed sustained reattachment, progressive corneal clearing, and stable visual improvement. Two years later, the graft remains fully attached and functionally stable.

Spontaneous complete reattachment after early DSAEK detachment can occur even in highly complex, vitrectomized eyes traditionally considered at high risk of failure. In clinically stable detachments with some graft–host contact, careful short-term observation may avoid additional surgical procedures.

In this case, the markedly reduced ocular motility caused by conjunctivo-orbital fibrosis and residual scleral buckle material resulted in a mechanically non-mobile eye with minimal residual ocular micro-movements. This mechanical stability, together with strict supine positioning, may have facilitated prolonged graft–stroma apposition and subsequent spontaneous adhesion.