title: Endophthalmitis after descemet stripping endothelial keratoplasty with concave-oriented dislocation on slit-lamp optical coherence topography.
abstract: OBJECTIVE
  To present the first reported case of Descemet membrane stripping endothelial keratoplasty (DSEK)-associated endophthalmitis with concave dislocation on slit-lamp optical coherence topography (SL-OCT).
  
  
  METHODS
  An 86-year-old man underwent DSEK for corneal decompensation secondary to prior surgery. On all postoperative visits, a slit-lamp examination and SL-OCT were performed.
  
  
  RESULTS
  On the first postoperative day, the lenticle was dislocated in a concave configuration as imaged with the SL-OCT. On the second postoperative day, the patient had eye pain, nausea, and increased intraocular pressure. On SL-OCT imaging, the concave configuration and fibrin stranding were imaged. With intraocular pressure lowering, the patient's pain subsided, and he was scheduled for a lenticle refloat the following day. The next day, endophthalmitis was diagnosed secondary to exuberant purulent inflammation. At surgery, the lenticle was removed, cultures were obtained, and pars plana vitrectomy and intravitreal injections were administered. Intraoperative cultures were positive for heavy growth of Streptococcus pneumoniae.
  
  
  CONCLUSIONS
  Endophthalmitis is a potential complication for any intraocular procedure including DSEK. SL-OCT imaging postoperatively may reveal concave lenticle configuration and subtle anterior chamber fibrin stranding may be early sign of endophthalmitis.
authors.affiliation: Department of Ophthalmology, The New York Eye and Ear Infirmary, New York, NY; and †New York Medical College, Valhalla, NY, USA. tikaiura@yahoo.com
authors.forename: Terry L
authors.initials: TL
authors.lastname: Kaiura
authors.forename: David C
authors.initials: DC
authors.lastname: Ritterband
authors.forename: Richard S
authors.initials: RS
authors.lastname: Koplin
authors.forename: Carolyn
authors.initials: C
authors.lastname: Shih
authors.forename: Pat M
authors.initials: PM
authors.lastname: Palmierto
authors.forename: John A
authors.initials: JA
authors.lastname: Seedor
mesh_terms: D000369:Aged, 80 and over; D057111:Descemet Stripping Endothelial Keratoplasty / Q000009:adverse effects*; D009877:Endophthalmitis / Q000209:etiology / Q000473:pathology*; D015818:Eye Infections, Bacterial / Q000209:etiology / Q000473:pathology*; D006801:Humans; D008297:Male; D011008:Pneumococcal Infections / Q000209:etiology*; D013296:Streptococcus pneumoniae / Q000302:isolation & purification; D041623:Tomography, Optical Coherence / Q000379:methods