title: Secondary angle closure caused by air migrating behind the pupil in descemet stripping endothelial keratoplasty.
abstract: OBJECTIVE
  To report secondary angle closure caused by air migrating behind the pupil in the context of intraocular pressure (IOP) elevation in the early postoperative period after Descemet stripping endothelial keratoplasty (DSEK).
  
  
  METHODS
  A retrospective case series was conducted on 100 consecutive DSEK cases from 90 patients undergoing DSEK because of corneal disease from Fuchs corneal dystrophy, pseudophakic bullous keratopathy, aphakic bullous keratopathy, and iridocorneal endothelial syndrome. Preoperative and postoperative slit-lamp examinations and IOP measurements were ascertained for all 100 eyes. Main outcome measures included preoperative and postoperative IOP.
  
  
  RESULTS
  Thirteen of 100 eyes developed an IOP rise of greater than 30 mm Hg on the first postoperative day. Six of these 13 patients developed angle closure from air migrating posterior to the iris and causing iridocorneal adhesions. One of these 13 patients developed pupillary block from air anterior to iris. Six of 13 patients developed increased IOP without pupillary block or iridocorneal adhesions and had a history of preexisting primary or secondary glaucoma.
  
  
  CONCLUSIONS
  A secondary angle closure associated with DSEK is reported with air migrating behind the iris, resulting in extensive iridocorneal adhesions. An acute increase in IOP after DSEK can also be induced by air anterior to the iris causing pupillary block. IOP spikes are much more common in the first few postoperative days after DSEK. Medical treatment can occasionally resolve air posterior to the iris, but if iridocorneal adhesions are extensive and persistent, air removal and angle reformation may be necessary.
authors.affiliation: From the Cornea, Cataract, and External Disease Service, The Wilmer Eye Institute, The Johns Hopkins Hospital, Baltimore, MD 21287, USA.
authors.forename: Jung S
authors.initials: JS
authors.lastname: Lee
authors.forename: Neel R
authors.initials: NR
authors.lastname: Desai
authors.forename: Gregory W
authors.initials: GW
authors.lastname: Schmidt
authors.forename: Albert S
authors.initials: AS
authors.lastname: Jun
authors.forename: Oliver D
authors.initials: OD
authors.lastname: Schein
authors.forename: Walter J
authors.initials: WJ
authors.lastname: Stark
authors.forename: Allen O
authors.initials: AO
authors.lastname: Eghrari
authors.forename: John D
authors.initials: JD
authors.lastname: Gottsch
mesh_terms: D000388:Air; D003316:Corneal Diseases / Q000188:drug therapy / Q000209:etiology / Q000601:surgery*; D016039:Corneal Transplantation / Q000009:adverse effects* / Q000379:methods*; D003886:Descemet Membrane / Q000601:surgery; D004728:Endothelium, Corneal / Q000601:surgery*; D015812:Glaucoma, Angle-Closure / Q000209:etiology* / Q000503:physiopathology / Q000628:therapy; D006801:Humans; D007429:Intraocular Pressure; D007499:Iris Diseases / Q000209:etiology / Q000628:therapy; D008499:Medical Records; D011184:Postoperative Period; D011681:Pupil Disorders / Q000209:etiology; D012189:Retrospective Studies; D013997:Time Factors; D000267:Tissue Adhesions / Q000209:etiology / Q000628:therapy