Femtosecond Laser Assisted Descemets Stripping Endothelial Keratoplasty In An Aphakic Vitrectomized, Oil Filled Eye Using Meshwork Support: A Complex Post-Traumatic Case In A 50-Year-Old Gentleman

Descemet’s Stripping Endothelial Keratoplasty (DSEK) in an aphakic, vitrectomized eyes presents significant technical challenges due to the absence of capsular support and altered intraocular dynamics, particularly in the presence of silicone oil. We present a case of a 50-year-old gentleman who underwent femtosecond laser-assisted DSEK in the left eye with complex pre-existing pathology. The left eye was orginally the better seeing eye however the patient sustained a complex globe rupture causing irreversible damage to the the iris, lens and retina.

The patient required multiple surgeries and was ultimately left with a silicone oil–filled aphakic eye with meshwork in situ to keep the oil in the posterior segment.This complex surgical catalogue led to the decompensation of the cornea and a clinical decision was made to undertake a DSEK to try and restore some vision and improve quality of life. Femtosecond-assisted DSEK was performed in this complex setting.

Donor graft preparation was first completed using a femtosecond laser. The host corneal epithelium was then debrided to improve visualization, followed by corneal marking to guide graft positioning. A main wound and paracentesis were created, and an anterior chamber maintainer was inserted to ensure chamber stability. Descemetorhexis was performed to remove the diseased endothelium and Descemet’s membrane. Intraoperatively, silicone oil was noted to egress continuously, adding to the complexity of chamber control. The donor graft was then carefully injected into the anterior chamber. The graft was positioned and secured with an air bubble, sutures were placed to close the wounds

Postoperatively, the patient required close monitoring. A multidisciplinary approach was taken in combination with the vitreoretinal surgeons. Several weeks down the line the graft remained clear and the patient reported an improvement in the vision.

This poster highlights the feasibility of femtosecond-assisted DSEK in complex aphakic, vitrectomized, silicone oil-filled eyes with appropriate surgical planning and adjunctive support. Careful postoperative monitoring remains essential to ensure optimal graft survival.