Post-Operative Management of Vitreous Adhesion after DSAEK

with YAG Laser Vitreolysis

Sherif Idris1, Ahmed Al-Ghoul2 MD FRCSC DipABO

1University of Calgary, Faculty of Medicine

2University of Calgary, Department of SurgeryDivision of Ophthalmology

The authors have no financial interest in material being presented

PurposePurpose

To present a newly reported post-To present a newly reported post-operative complication from DSAEK, operative complication from DSAEK, vitreous prolpase and adhesion to vitreous prolpase and adhesion to corneal graft, and show our corneal graft, and show our management technique. management technique.

MethodsMethods

Case reports describing two patients Case reports describing two patients with similar complications of vitreous with similar complications of vitreous adhesion to corneal graft after adhesion to corneal graft after DSAEK surgery. DSAEK surgery.

ResultsResults

The first patient was a 65 year old Caucasian female diagnosed with The first patient was a 65 year old Caucasian female diagnosed with Pseudophakic Bullous Keratopathy (PBK) who had DSAEK performed. Pseudophakic Bullous Keratopathy (PBK) who had DSAEK performed. Eleven days post-operatively a vitreous wick was noted attached to Eleven days post-operatively a vitreous wick was noted attached to the corneal graft (Photo1). Patient was on prednisolone acetate 1% the corneal graft (Photo1). Patient was on prednisolone acetate 1% drops four times daily and continued on that regimen. At one month drops four times daily and continued on that regimen. At one month follow-up, the patient presented with corneal edema secondary to follow-up, the patient presented with corneal edema secondary to acute graft rejection (photo 2). The prolapsed vitreous wick was acute graft rejection (photo 2). The prolapsed vitreous wick was suspected to be the source of graft rejection. The patient was suspected to be the source of graft rejection. The patient was treated with hourly prednisolone acetate drops which completely treated with hourly prednisolone acetate drops which completely resolved the rejection episode. She subsequently underwent resolved the rejection episode. She subsequently underwent Neodymium YAG vitreolysis performed with resultant release of Neodymium YAG vitreolysis performed with resultant release of vitreous adhesion (photo 3). At the 3 months visit post-YAG she was vitreous adhesion (photo 3). At the 3 months visit post-YAG she was noted to have uncorrected visual acuity of 20/40. noted to have uncorrected visual acuity of 20/40.

The second patient was 83 year old female Caucasian who had The second patient was 83 year old female Caucasian who had DSAEK performed also for PBK. She later presented with vitreous DSAEK performed also for PBK. She later presented with vitreous wick adhesion to corneal graft approximately 3 months post-wick adhesion to corneal graft approximately 3 months post-operatively. She subsequently underwent YAG vitreolysis. At the 2 operatively. She subsequently underwent YAG vitreolysis. At the 2 week visit post-YAG laser she was noted to have a corrected visual week visit post-YAG laser she was noted to have a corrected visual acuity of 20/50.acuity of 20/50.

Photo 1: Vitreous Wick Adhesion to Photo 1: Vitreous Wick Adhesion to DSAEK Corneal GraftDSAEK Corneal Graft

Photo 2: DSAEK Corneal Graft Rejection Photo 2: DSAEK Corneal Graft Rejection with Associated Vitreous Wick Adhesionwith Associated Vitreous Wick Adhesion

Photo 3: Appearance of Graft Photo 3: Appearance of Graft after YAG Vitreolysisafter YAG Vitreolysis

ConclusionConclusion

Vitreous prolapse with adhesion to corneal Vitreous prolapse with adhesion to corneal graft is a newly reported complication that graft is a newly reported complication that can occur after DSAEK. Possible causes for can occur after DSAEK. Possible causes for vitreous proplase can be from undetected vitreous proplase can be from undetected zonular damage from previous surgery or zonular damage from previous surgery or intra-operative damage to zonules during intra-operative damage to zonules during donor graft insertion. It is recommended to donor graft insertion. It is recommended to use YAG laser to disrupt the vitreous use YAG laser to disrupt the vitreous adhesions post-operatively so as to avoid adhesions post-operatively so as to avoid possible graft rejection and failure.possible graft rejection and failure.

ReferencesReferences

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