Treatment of Descemet's membrane detachment after primary Descemet's stripping automated endothelial keratoplasty during surgery using intraoperative optical coherence tomography

PURPOSE: To present a novel microscope-integrated optical coherence tomography (iOCT)-guided surgical technique wherein Descemet's membrane detachment (DMD), occurring during vitrectomy, was treated intraoperatively in a patient who had previously undergone Descemet's stripping automated endothelial keratoplasty (DSAEK). OBSERVATIONS: The surgical technique was performed on a 75-year-old man with a history of DSAEK to intraoperatively treat DMD, which occurred during vitrectomy in the left eye. A fine needle mounted on a syringe was inserted into the supra-Descemet's space under iOCT guidance. The location of the needle was easily identified by its high reflection. The interface fluid was safely aspirated under excellent visualization of the needle tip and the interface. Successful aspiration of the interface fluid was confirmed via iOCT imaging at the end of the surgery. The graft has remained well attached to the cornea throughout the one-year postoperative follow-up. CONCLUSION AND IMPORTANCE: iOCT-guided surgical interventions provide a safe and accurate approach for treating intraoperative complications in eyes with a history of DSAEK.