International Ophthalmology

, Volume 32, Issue 6, pp 607–610 | Cite as

Management of detached graft donor by SF6 injection following Descemet stripping automated endothelial keratoplasty of an eye with iridocorneal endothelial syndrome and Ahmed glaucoma drainage tube

  • Kansu Tahir Bozkurt
  • Banu Torun Acar
  • Suphi Acar
Case Report


A 65-year-old woman with iridocorneal endothelial syndrome and a history of Ahmed glaucoma drainage (AGD) tube implantation underwent Descemet stripping automated endothelial keratoplasty (DSAEK) in her right eye. During the procedure, filling the anterior chamber with air was quite difficult due to escape of air via the AGD tube and a complete air fill of the anterior chamber could only be managed after multiple attempts. On operation night, there was no air left in the anterior chamber. On postoperative day 1, graft detachment was determined by slit-lamp biomicroscopy. For rebubbling, sulfur hexafluoride (SF6) 20 % was injected into the anterior chamber. Two days later, there was still some SF6 in the anterior chamber and the graft was completely attached. At postoperative week 2, visual acuity was 2/10. SF6 use may be considered for DSAEK in cases of previous AGD tube implantation history due to its potential for longer duration in order to obtain a better tamponade with the bubble due to its expanding nature.


Descemet stripping automated endothelial keratoplasty Graft detachment Iridocorneal endothelial syndrome SF6 for rebubbling 


  1. 1.
    Shields MB, Campbell DG, Simmons RJ (1978) The essential iris atrophies. Am J Ophthalmol 85:749–759PubMedGoogle Scholar
  2. 2.
    Campbell DG, Shields MB, Smith TR (1978) The corneal endothelium and the spectrum of essential iris atrophy. Am J Ophthalmol 86:317–324PubMedGoogle Scholar
  3. 3.
    Shields MB (1979) Progressive essential iris atrophy, Chandler’s syndrome, and the iris nevus (Cogan–Reese) syndrome: a spectrum of disease. Surv Ophthalmol 24:3–20PubMedCrossRefGoogle Scholar
  4. 4.
    Doe EA, Budenz DL, Gedde SJ, Imami NR (2001) Long-term surgical outcomes of patients with glaucoma secondary to the iridocorneal endothelial syndrome. Ophthalmology 108:1789–1795PubMedCrossRefGoogle Scholar
  5. 5.
    Alvim PT, Cohen EJ, Rapuano CJ, Chung CW, Pereira ML, Eagle RC Jr, Katz LJ, Smith AF, Laibson PR (2001) Penetrating keratoplasty in iridocorneal endothelial syndrome. Cornea 20:134–140PubMedCrossRefGoogle Scholar
  6. 6.
    Crawford GJ, Stulting RD, Cavanagh HD, Waring GO 3rd (1989) Penetrating keratoplasty in the management of iridocorneal endothelial syndrome. Cornea 8:34–40PubMedCrossRefGoogle Scholar
  7. 7.
    Price MO, Price FW Jr (2010) Endothelial keratoplasty—a review. Clin Exp Ophthalmol 38:128–140. doi:10.1111/j.1442-9071.2010.02213.x CrossRefGoogle Scholar
  8. 8.
    Bahar I, Kaiserman I, Buys Y, Rootman D (2008) Descemet’s stripping with endothelial keratoplasty in iridocorneal endothelial syndrome. Ophthalmic Surg Lasers Imaging 39:54–56PubMedCrossRefGoogle Scholar
  9. 9.
    Price MO, Price FW Jr (2007) Descemet stripping with endothelial keratoplasty for treatment of iridocorneal endothelial syndrome. Cornea 26:493–497. doi:10.1097/ICO.0b013e318030d274 PubMedCrossRefGoogle Scholar
  10. 10.
    Ide T, Yoo SH, Leng T, O’Brien TP (2009) Subconjunctival air leakage after Descemet’s stripping automated endothelial keratoplasty (DSAEK) in a post-trabeculectomy eye. Open Ophthalmol J 3:1–2. doi:10.2174/1874364100903010001 PubMedCrossRefGoogle Scholar
  11. 11.
    Banitt M, Arrieta-Quintero E, Parel JM, Fantes F (2011) Technique for air bubble management during endothelial keratoplasty in eyes after penetrating glaucoma surgery. Cornea 30:184–188. doi:10.1097/ICO.0b013e3181e9b687 PubMedCrossRefGoogle Scholar
  12. 12.
    Riaz KM, Sugar J, Tu EY, Edward DP, Wilensky JT, Namavari A, Djalilian AR (2009) Early results of Descemet-stripping and automated endothelial keratoplasty (DSAEK) in patients with glaucoma drainage devices. Cornea 28:959–962. doi:10.1097/ICO.0b013e31819c4e2c PubMedCrossRefGoogle Scholar
  13. 13.
    Kim P, Amiran MD, Lichtinger A, Yeung SN, Slomovic AR, Rootman DS (2012) Outcomes of descemet stripping automated endothelial keratoplasty in patients with previous glaucoma drainage device insertion. Cornea 31:172–175. doi:10.1097/ICO.0b013e318224820a PubMedCrossRefGoogle Scholar
  14. 14.
    Wiaux C, Baghdasaryan E, Lee OL, Bourges JL, Deng SX, Yu F, Aldave AJ (2011) Outcomes after Descemet stripping endothelial keratoplasty in glaucoma patients with previous trabeculectomy and tube shunt implantation. Cornea 30:1304–1311. doi:10.1097/ICO.0b013e3182114297 PubMedCrossRefGoogle Scholar
  15. 15.
    Phillips PM, Terry MA, Shamie N, Chen ES, Hoar K, Dhoot D, Shah AK, Friend DJ, Rao NK, Davis-Boozer DD (2010) Descemet stripping automated endothelial keratoplasty in eyes with previous trabeculectomy and tube shunt procedures: intraoperative and early postoperative complications. Cornea 29:534–540. doi:10.1097/ICO.0b013e3181c11bf3 PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media B.V. 2012

Authors and Affiliations

  • Kansu Tahir Bozkurt
    • 1
    • 3
  • Banu Torun Acar
    • 2
  • Suphi Acar
    • 2
  1. 1.Department of OphthalmologyUmraniye Education and Research HospitalIstanbulTurkey
  2. 2.Department of OphthalmologyHaydarpasa Education and Research HospitalIstanbulTurkey
  3. 3.Ümraniye Eğitim ve Araştırma Hastanesi Göz KliniğiIstanbulTurkey

Personalised recommendations