Spontaneous Reattachment of Descemet Stripping Automated Endothelial Keratoplasty Lenticles: A Case Series of 12 Patients

Hayes, Daniel D.; Shih, Carolyn Y.; Shamie, Neda; Terry, Mark A.; Price, Francis W.; Price, Marianne O.; Ritterband, David C.; Hannush, Sadeer B.; Gorovoy, Mark S.; Weisenthal, Robert W.; Ritch, Robert; Liebmann, Jeffrey M.; Udell, Ira J.

doi:10.1016/j.ajo.2010.06.008

« Previous Next »American Journal of Ophthalmology
Volume 150, Issue 6 , Pages 790-797.e2, December 2010

Spontaneous Reattachment of Descemet Stripping Automated Endothelial Keratoplasty Lenticles: A Case Series of 12 Patients

Daniel D. Hayes
- Department of Ophthalmology, North Shore—Long Island Jewish Health System, Great Neck, New York
Carolyn Y. Shih
- Department of Ophthalmology, North Shore—Long Island Jewish Health System, Great Neck, New York
- Inquiries to Carolyn Y. Shih, Department of Ophthalmology, North Shore—Long Island Jewish Health System, 600 Northern Boulevard, Suite 214, Great Neck, NY 11040
Neda Shamie
- Department of Ophthalmology, Devers Eye Institute, Portland, Oregon
Mark A. Terry
- Department of Ophthalmology, Devers Eye Institute, Portland, Oregon
Francis W. Price Jr.
- Price Vision Group, Indianapolis, Indiana
- Department of Ophthalmology, Cornea Research Foundation of America, Indianapolis, Indiana
Marianne O. Price
- Price Vision Group, Indianapolis, Indiana
- Department of Ophthalmology, Cornea Research Foundation of America, Indianapolis, Indiana
David C. Ritterband
- Department of Ophthalmology, New York Eye and Ear Infirmary, New York, New York
Sadeer B. Hannush
- Department of Ophthalmology, Wills Eye Institute, Thomas Jefferson University, Philadelphia, Pennsylvania
Mark S. Gorovoy
- Department of Ophthalmology, Gorovoy MD Eye Specialists, Fort Myers, Florida
Robert W. Weisenthal
- Department of Ophthalmology, SUNY Upstate Medical University, Syracuse, New York
Robert Ritch
- Department of Ophthalmology, New York Eye and Ear Infirmary, New York, New York
- Department of Ophthalmology, New York Medical College, Valhalla, New York
Jeffrey M. Liebmann
- Department of Ophthalmology, New York Eye and Ear Infirmary, New York, New York
Ira J. Udell
- Department of Ophthalmology, North Shore—Long Island Jewish Health System, Great Neck, New York
- Albert Einstein College of Medicine, Bronx, New York

Accepted 12 June 2010. published online 01 September 2010.

Purpose

To review 12 cases of postoperative detachment and spontaneous reattachment of Descemet stripping automated endothelial keratoplasty (DSAEK) lenticles.

Design

Retrospective, observational case series.

Methods

This was a review of patients undergoing DSAEK at 7 institutions. Patients who had a significant detachment of their DSAEK lenticle during the postoperative period were identified and divided into 2 groups. Significant detachment was defined as either complete central interface fluid with bare peripheral attachment (group 1) or a free-floating lenticle in the anterior chamber (group 2). Patients who subsequently had a spontaneous reattachment of the lenticle were identified, with data regarding surgical technique and intraoperative and postoperative complications collected for analysis.

Results

Our cohort consisted of 12 eyes of 12 patients who met the definition of significant postoperative detachment with subsequent spontaneous reattachment. Four patients had complete central detachment with peripheral attachment (group 1), whereas 8 patients had a free-floating lenticle (group 2). Ten of the 12 patients had a successful outcome as defined as an attached and clear DSAEK lenticle. In our study, reattachment was seen as early as 5 days and as late as 7 months after surgery, with reattachment in 9 of 12 patients by day 25.

Conclusions

Spontaneous reattachment of detached DSAEK lenticles may occur during the postoperative period. The decision of when to bring the patient back for a rebubble ultimately must be made on a case-by-case basis.