title: Dislocation of the donor graft to the posterior segment in descemet stripping automated endothelial keratoplasty.
abstract: OBJECTIVE
  To report a series of dislocations of the donor graft into the posterior segment associated with Descemet stripping endothelial keratoplasty (DSAEK) and to identify possible risk factors for dislocation and clinical outcomes.
  
  
  METHODS
  Retrospective case series.
  
  
  METHODS
  Cases of donor graft dislocation into the posterior segment associated with endothelial keratoplasty were identified from the clinical experience of 7 surgeons. Observations included the preoperative surgical history of each eye, preoperative and postoperative visual acuity, management of the complication, and the postoperative clinical course. No identified cases were excluded from this series.
  
  
  RESULTS
  Eight posterior graft dislocations were associated with DSAEK surgery. Each eye had a history of vitrectomy. Five eyes had sutured posterior chamber intraocular lenses, 1 eye had a sulcus intraocular lens, and 2 eyes were aphakic. Each eye required repeat grafting, and in 6 of 8 eyes, pars plana vitrectomy was used to remove the dislocated graft. Final visual acuities ranged from 20/30 to no light perception.
  
  
  CONCLUSIONS
  Graft dislocation into the posterior segment is a rare complication of DSAEK surgery that can lead to permanent vision loss. It has occurred in eyes that have undergone previous vitrectomy and complicated intraocular lens placement or were aphakic. As is the case with a dropped lens nucleus during cataract extraction, visual acuities after a dropped DSAEK graft range from very good to no light perception. Better postoperative results seem to be associated with prompt removal of the posteriorly dislocated graft.
authors: Duke Eye Center, Durham, North Carolina 27710, USA. natalie.afshari@duke.edu
authors: Natalie A
authors: NA
authors: Afshari
authors: Mark S
authors: MS
authors: Gorovoy
authors: Sonia H
authors: SH
authors: Yoo
authors: Terry
authors: T
authors: Kim
authors: Alan N
authors: AN
authors: Carlson
authors: George O D
authors: GO
authors: Rosenwasser
authors: Neil B
authors: NB
authors: Griffin
authors: Brooks W
authors: BW
authors: McCuen
authors: Cynthia A
authors: CA
authors: Toth
authors: Francis W
authors: FW
authors: Price
authors: Marianne
authors: M
authors: Price
authors: Mark M
authors: MM
authors: Fernandez
mesh_terms: D000368:Aged; D057111:Descemet Stripping Endothelial Keratoplasty / Q000009:adverse effects*; D004728:Endothelium, Corneal / Q000473:pathology*; D005260:Female; D006084:Graft Rejection / Q000209:etiology*; D006801:Humans; D008297:Male; D057972:Posterior Eye Segment / Q000473:pathology*; D012086:Reoperation; D012189:Retrospective Studies; D012307:Risk Factors; D014019:Tissue Donors; D016896:Treatment Outcome; D014792:Visual Acuity / Q000502:physiology; D014821:Vitrectomy