Management of posteriorly dislocated endothelial keratoplasty donor lenticule.
OBJECTIVE
The purpose of this study was to describe the management of a keratoplasty lenticule adhering to the retina after intraoperative dislocation.


METHODS
We describe the posterior dislocation of the donor lenticule during endothelial keratoplasty in a 72-year-old woman with a transscleraly sutured intraocular lens, previous pars plana vitrectomy, and a posteriorly positioned Ahmed glaucoma tube shunt. The lenticule was retrieved through a pars plana approach 2 weeks later, at which time it was tightly adherent to the extramacular retina. Concurrent keratoplasty was performed.


RESULTS
Six months after retrieval of the dislocated lenticule with repeat keratoplasty, the retinal examination is stable and the new graft remains attached.


CONCLUSIONS
An iris defect, the absence of capsular support, and a history of previous vitrectomy are all potential risk factors for the intraoperative migration of a keratoplasty lenticule. The surgical view 2 weeks after dislocation was not a limiting factor in the retrieval of the lenticule. However, the tight adherence of the lenticule to the retina required extensive peeling. To avoid a more difficult surgical repair and the potential for scar formation, earlier surgical repair would be preferable, especially if dealing with a macular location.
From the *Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio; †Department of Anatomic Pathology, Cleveland Clinic, Cleveland, Ohio; ‡Department of Biomedical Engineering, Cleveland Clinic, Cleveland, Ohio; and §Department of Transplant, Cleveland Clinic, Cleveland, Ohio.
Mark R
MR
Barakat
Reecha
R
Sachdeva
Ricardo N
RN
Sepulveda
Lynn
L
Schoenfield
William J
WJ
Dupps
Jonathan E
JE
Sears