Posters

Anterior segment optical coherence tomography in the early detection of graft detachment after Descemet membrane endothelial keratoplasty and postoperative follow-up: a case report

Poster Details

First Author: A.Ceausescu SPAIN

Co Author(s): N. Doménech Aracil   M. Martinez Hergueta   J. Pérez Santonja              

Abstract Details

Purpose:

To describe the importance of anterior segment optical coherence tomography (AS-OCT) in the postoperative management of Descemet membrane endothelial keratoplasty (DMEK)

Setting:

Department of Ophthalmology. Hospital General Universitario de Alicante. Alicante. Spain

Methods:

A 78-year-old man with a history of phacoemulsification and intraocular lens implantation three years ago in both eyes, presented to our hospital referring progressive vision loss in his left eye (LE). His best-corrected visual acuity (BCVA) was 20/30 in his right eye (RE) and 20/200 in his LE. Biomicroscopy revealed corneal edema with bullae formation in his LE and no endothelial cells were visualized on specular microscopy. RE examination was unremarkable, but the density of endothelial cells was 1224 cells/mm2. The patient underwent DMEK surgery in his LE and AS-OCT was performed during the follow-up.

Results:

On the first postoperative day AS-OCT revealed the initial adhesion of the DMEK donor. 1 week after surgery a localized area of corneal edema remained in biomicroscopy. AS-OCT confirmed that the graft was detached inferiorly and temporally. We decided to “rebubble” injecting 20% sulfur hexafluoride (SF6) gas into the anterior chamber in order to re-attach the graft donor to the recipient stroma. One week after this procedure, AS-OCT showed complete attachment of the DMEK graft. By the first postoperative month, the cornea was clear and BCVA improved to 20/40. AS-OCT images revealed complete graft adhesion and reduction in corneal thickness.

Conclusions:

AS-OCT system is a useful tool for DMEK surgery by providing high-resolution images during postoperative follow-up. It has an important role to monitor graft adhesion postoperatively, early detection of graft detachments, help decide if secondary intervention is required and follow-up after “rebubbling” procedures.

Financial Disclosure:

None