Pressure-Induced Interlamellar Stromal Keratitis After Laser In Situ Keratomileusis

Abstract

The authors report a case of a Descemet stripping automated endothelial keratoplasty that was complicated by intraoperative bleeding from the iridotomy site. Slit-lamp examination on postoperative day 1 revealed significant amount of retained blood at the donor-recipient interface and a best-corrected visual acuity (BCVA) of 20/400. The patient was managed with periodic observation and a topical fluoroquinolone and 1% prednisolone. By postoperative month 8, the interface had cleared, and the BCVA improved to 20/50. The patient remained with a clear cornea and stable BCVA of 20/50 at her most recent 1-year postoperative follow-up examination. Performing an intraoperative peripheral iridotomy to reduce the risk of air-associated pupillary block introduces the risk of its inherent complications, including intraoperative bleeding, retained blood cells at the interface, and delayed visual recovery. In this case, periodic observation and conservative management with topical steroids resulted in the resolution of the interface debris, associated keratitis, and improved postoperative visual acuity.

Textural Interface Opacity After Descemet Stripping Automated Endothelial Keratoplasty

“…3,5,17,18,19 Other possible interface abnormalities, such as blood, inflammatory or epithelial cells, metallic particles, calcareous degeneration, or retained Descemet membrane, have been reported. 11,17,[20][21][22][23] Although there have been a few small case series reporting an interface haze or opacity, this is the largest case series to describe the condition with its potential impact on visual outcomes. 18,19,[24][25][26][27] In this case series, there were no signs of inflammation, rejection, edema, or infiltrate in association with the interface opacity.…”

“…[3][4][5][6][7][8][9][10][11][12][13] We report a case series of 30 patients who developed varying degrees of interface opacity at the level of the graft-host interface after DSAEK. Although the exact etiology of this finding remains unknown, the study provides new valuable information regarding long-term visual outcomes and potential causes for the opacity, including retained viscoelastic and an irregular stromal surface of the donor tissue, with slightly different clinical presentations.…”

Severe and Recurrent Interface Hemorrhage after Endothelial Keratoplasty

“…Persistent blood in the graft-host interface may be associated with development of late corneal haze and a subsequent decrease in visual performance and acuity. Schmitt et al 8 recently reported a case with intraoperative interface bleeding from a peripheral iridotomy during DSEK. Repeated attempts were made to wash the interface during the surgery.…”

“…1,2 Complication rates in literature are variable and dependent on the experience of surgeons, patients' factors, and the surgical techniques used. [1][2][3][4][5][6][7][8] In a case file analysis of 118 patients undergoing DSEK, Suh et al reported a myriad of complications, including retinal detachment, cystoid macular edema, epithelial ingrowth, and retained blood, at the donor-host interface. 3 Other less commonly reported complications include lamellar disc and intraocular lens dislocation into the vitreous cavity, herpetic keratitis, retrocorneal fibrous membrane, and aqueous misdirection syndrome.…”

Inadvertent Placement of a Glaucoma Tube Into the Graft-Host Interface of an Eye With Previous Descemet Stripping Automated Endothelial Keratoplasty

“…Previously described graft-host DSAEK interface complications include postoperative vascularization, sequestered blood, microbial keratitis, retained metallic particles, epithelial ingrowth, retained fragments of Descemet membrane, and calcareous degeneration. [1][2][3][4][5][6][7][8] We report a unique interface complication in an aniridic patient with a complicated ocular history including previous DSAEK under PKP, who underwent secondary placement of a Baerveldt glaucoma tube shunt. Postoperatively, the tube was found to be positioned in the DSAEK-PKP interface, requiring tube repositioning at the time of subsequent repeat PKP and placement of a Boston type I keratoprosthesis.…”