Spontaneous Reattachment of a Posteriorly Dislocated Endothelial Graft: A Case Report

A thirty-year-old Chinese man with a history of severe trauma to his right eye, with secondary sectoral aniridia and multiple operations including intraocular lens insertion more than fifteen years ago, underwent an uneventful Descemet's Stripping Automated Endothelial Keratoplasty (DSAEK) for his pseudophakic bullous keratopathy in a tertiary hospital in Hong Kong. The nature of his previous operations was unknown to the surgeon at the time of transplant. On postoperative day one, the graft was not present in the anterior chamber. Fundal view was limited because of corneal oedema. B-scan ultrasonography could not detect any definite presence of a donor button in the posterior segment as gas was present in the vitreous cavity. The patient was instructed to lie prone full time, and on postoperative day three, the graft was found to be reattached to the stroma with spontaneous resolution of corneal oedema, indicating restoration of pump function of endothelium graft. This is the first case of spontaneous reattachment of a posteriorly dislocated endothelial graft without surgical intervention or abandonment of the grafted endothelial button. 1. Case Report A thirty-year-old Chinese man with a history of severe trauma to his right eye more than fifteen years ago and multiple operations done was scheduled for DSAEK for his pseudophakic bullous keratopathy in June 2012. As the patient could not recall the timing and nature of the procedures he had previously undergone, his archived old medical records were also not available, and hence details of his previous operations were not known to the operating surgeon at the time of transplantation. The patient could not recall whether his intraocular lens was scleral-fixated or a normal posterior capsule intraocular lens. Preoperative visual acuity was 20/200 and examination found pseudophakic bullous keratopathy with traumatic aniridia from 9 to 6 hours. No conjunctival bleb was seen. One faint subconjunctival suture was seen at 4 o’clock with the presence of an intraocular lens. The patient had surgery under retrobulbar anaesthesia. DSAEK button of 8？mm was prepared with a Barron Donor Cornea Punch. After temporal peritomy, a temporal scleral tunnel 6？mm was prepared. The Descemet’s membrane was stripped (and edges of stroma roughened) and later was removed through the limbal tunnel in a viscoelastic filled anterior chamber (AC). The AC was then flushed thoroughly with the presence of an infusion cannula as AC maintainer. ACIOL plastic glide was inserted into AC, and the DSAEK button was pulled into the eye by