Surgical management of a posterior dislocated intraocular lens after descemet stripping automated endothelial keratoplasty.
OBJECTIVE
To describe the occurrence and management of a posterior chamber intraocular lens (IOL) dislocation into the vitreous cavity after Descemet stripping automated endothelial keratoplasty (DSAEK).


METHODS
We describe the clinical course of a pseudophakic patient with Fuchs endothelial dystrophy and previous Neodymium: Yttrium-Aluminum-Garnet (Nd:YAG) laser capsulotomy who underwent DSAEK. On postoperative day 10, the patient was examined and a detachment of the DSAEK graft was noted. After disc reattachment with use of an air bubble, the patient's vision did not clear because of persistent edema, but he appreciated a new large floater. A diagnosis of iatrogenic graft failure was made, and ultrasound examination confirmed dislocation of a plate-haptic silicone IOL into the vitreous cavity. The patient was treated with pars plana vitrectomy and concurrent penetrating keratoplasty.


RESULTS
One year after penetrating keratoplasty, the patient had a visual acuity of 20/60 with mild neurotrophic keratopathy and irregular astigmatism.


CONCLUSIONS
The use of intraocular air at the time of graft repositioning can induce posterior dislocation of an IOL in the setting of a YAG capsulotomy opening.
Rauen
Matthew
M
Department of Ophthalmology and Visual Sciences, University of Iowa, Iowa City, IA, USA.
Russell
Stephen R
SR
Tauber
Shachar
S
Goins
Kenneth Mark
KM
D000368:Aged; D057111:Descemet Stripping Endothelial Keratoplasty / Q000009:adverse effects*; D005548:Foreign-Body Migration / Q000209:etiology / Q000601:surgery*; D005642:Fuchs' Endothelial Dystrophy / Q000601:surgery*; D006801:Humans; D015948:Keratoplasty, Penetrating; D007910:Lenses, Intraocular; D008297:Male; D011475:Prosthesis Failure; D019591:Pseudophakia / Q000209:etiology; D014792:Visual Acuity; D014821:Vitrectomy