The lost graft
First Author: M.Ismail SINGAPORE
Co Author(s): J. Tan J. Ng Y. Hah A. Lau W. Heng
To report a case of a rare intraoperative complication of an expulsion of the endothelial graft out of the eye during DSAEK.
A 75 Chinese gentleman was referred to the corneal service for left pseudophakic bullous keratopathy. He had a history of left phacoemulsification, complicated by postoperative intraocular lens subluxation with vitreous in the anterior chamber requiring a vitrectomy and intraocular lens explantation with iris fixated intraocular lens in 2014
On examination, his visual acuity of the right eye was 6/9 and left eye 6/120. There was left corneal edema with bullae and DM folds. He was listed for a Left DSAEK.
Intraoperatively, the insertion of the endothelial graft was uneventful, and the new temporal wound was sutured. During the injection of air into the anterior chamber, there was a sudden iris prolapse through an old surgical wound, anterior to the new wound, and the graft was no longer seen in the eye. The iris fixated IOL seemed tilted but examination of the posterior segment was normal, with no signs of the graft. An external search was done and the graft was seen away from the surgical field.
This case report demonstrates a rare intraoperative complication of a sudden expulsion of the graft through an old side port wound during injection of air into the anterior chamber. It highlights the importance of identifying all wounds (including old wounds) and suturing them before injection of air during DSAEK to prevent a lost graft.