Spontaneous Reattachment of a Detached Sutured Descemet-Stripping Automated Endothelial Keratoplasty Graft

Abstract

Introduction: This is a case report of a spontaneous reattachment of Descemet-stripping automated endothelial keratoplasty (DSAEK). This graft was primarily sutured, and 20% sulfur hexafluoride (SF6) was injected into the anterior chamber, followed by graft detachment and spontaneous reattachment, 3 months later.

Case presentation: A 78-year-old male presented with DSAEK graft detachment, which was the patient's second DSAEK (the first also did not adhere). During the second surgery, the DSAEK graft was sutured and 20% SF6 was injected intraoperatively. Graft reattachment occurred without any intervention or repositioning 3 months after the 2nd DSAEK surgery.

Conclusion: Spontaneous DSEAK late graft reattachment is possible, particularly in the setting of an anchoring suture. In some patients, waiting can be an option that can spare the patient the possible risks of graft repositioning, rebubbling, or repeating the DSAEK. Suturing the DSAEK graft primarily may have served as an anchor to keep the graft approximate and aid in attachment. A graft suture can be considered in the setting of a previously failed DSAEK due to DSAEK graft detachment.

Keywords: Descemet-stripping automated endothelial keratoplasty; Graft detachment; Graft reattachment; Sutured Descemet-stripping automated endothelial keratoplasty graft.

Fig. 1.

Scheimpflug image showing a partially detached lower part of the DSAEK graft (left-hand side), 7 weeks after DSAEK.

Fig. 2.

Photo slit-lamp images 13 weeks after DSAEK surgery. a DSAEK graft is reattached and cleared. b Suture in the graft at 1 o’clock (blue arrow). c Anterior segment OCT showing attached DSAEK graft 13 weeks after DSAEK surgery.

Fig. 3.

Anterior segment OCT 5 months after DSAEK surgery showing that the graft is still attached. a is a scan in the lower nasal quadrant and b is in the lower temporal quadrant.