Post-Operative Management of Vitreous Adhesion after DSAEK with YAG Laser Vitreolysis

1

• 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
Surgery Division of Ophthalmology The authors
have no financial interest in material being
presented
2
Purpose

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

3
Methods

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

4
Results

• The first patient was a 65 year old Caucasian
  female diagnosed with Pseudophakic Bullous
  Keratopathy (PBK) who had DSAEK performed. Eleven
  days post-operatively a vitreous wick was noted
  attached to the corneal graft (Photo1). Patient
  was on prednisolone acetate 1 drops four times
  daily and continued on that regimen. At one month
  follow-up, the patient presented with corneal
  edema secondary to acute graft rejection (photo
  2). The prolapsed vitreous wick was suspected to
  be the source of graft rejection. The patient was
  treated with hourly prednisolone acetate drops
  which completely resolved the rejection episode.
  She subsequently underwent Neodymium YAG
  vitreolysis performed with resultant release of
  vitreous adhesion (photo 3). At the 3 months
  visit post-YAG she was noted to have uncorrected
  visual acuity of 20/40.
• The second patient was 83 year old female
  Caucasian who had DSAEK performed also for PBK.
  She later presented with vitreous wick adhesion
  to corneal graft approximately 3 months
  post-operatively. She subsequently underwent YAG
  vitreolysis. At the 2 week visit post-YAG laser
  she was noted to have a corrected visual acuity
  of 20/50.

5
Photo 1 Vitreous Wick Adhesion to DSAEK Corneal
Graft
6
Photo 2 DSAEK Corneal Graft Rejection with
Associated Vitreous Wick Adhesion
7
Photo 3 Appearance of Graft after YAG
Vitreolysis
8
Conclusion

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

9
References

1. Terry MA. Endothelial Keratoplasty (EK) history,
   current state, and future directions Editorial.
   Cornea. 200625873878.
2. Lee, WB, et al. Descemets Stripping Endothelial
   Keratoplasty Safety and Outcomes A report by
   the American Academy of Ophthalmology.
   Ophthalmology. 2009 116(9) 1818-1830.
3. Newsome DA, Michels RG. Detection of lymphocytes
   in the vitreous gel of patients with retinitis
   pigmentosa. Am J Ophthalmol. 1988105(6)596-602.
4. Tchah, H, et al. Neodymium YAG Laser Vitreolysis
   for Treatment and Prophylaxis of Cystoid Macular
   Oedema. Aust N Z J Ophthalmol. 1989 17(2)
   179-183.