Posterior Segment Complications of Endothelial Keratoplasty

Abstract

Endothelial keratoplasty is the most commonly performed type of corneal transplant in the United States, currently accounting for 60% of total grafts. The anterior segment complications are well documented; however, the posterior segment complications may not be as familiar to the anterior segment surgeon. These include endophthalmitis, cystoid macular edema (CME), choroidal detachment, graft dislocation to the posterior segment, and retinal detachment. CME is the most common postoperative retinal complication with a reported incidence of up to 12.5%, which usually responds well to topical therapy. This article will review the incidence, prevention and management of posterior segment complications after endothelial keratoplasty.

Figure 1.. Fungal Endophthalmitis Following DSAEK.

External slit lamp photograph of a 66-year-old man who developed pain in the left eye two months following DSAEK. The eye was painful, vision was markedly decreased, and a B-scan ultrasonography revealed vitreous membranes. The patient underwent removal of the graft, temporary keratoprosthesis, removal of his intraocular lens, pars plana vitrectomy, injection of anti-fungal agents and penetrating keratoplasty. While cultures were negative, pathological examination of the infected graft disclosed fungal elements, believed to have originated from the initial graft. Figure courtesy of Harry Flynn, Jr. MD.

Figure 2.. Cystoid macular edema following DSEK.

Black and white macular OCT image of a 58-year-old male who had undergone EK in his right eye six weeks prior to this image. He displays classic cystic changes within the retinal layers and vision was about 20/60. After eight weeks of topical therapy with a steroid and NSAID, his best corrected vision had improved to 20/25.