Surgical management of a posterior dislocated intraocular lens after descemet stripping automated endothelial keratoplasty.

PURPOSE: To describe the occurrence and management of a posterior chamber intraocular lens (IOL) dislocation into the vitreous cavity after Descemet stripping automated endothelial keratoplasty (DSAEK). METHODS: We describe the clinical course of a pseudophakic patient with Fuchs endothelial dystrophy and previous Neodymium: Yttrium-Aluminum-Garnet (Nd:YAG) laser capsulotomy who underwent DSAEK. On postoperative day 10, the patient was examined and a detachment of the DSAEK graft was noted. After disc reattachment with use of an air bubble, the patient's vision did not clear because of persistent edema, but he appreciated a new large floater. A diagnosis of iatrogenic graft failure was made, and ultrasound examination confirmed dislocation of a plate-haptic silicone IOL into the vitreous cavity. The patient was treated with pars plana vitrectomy and concurrent penetrating keratoplasty. RESULTS: One year after penetrating keratoplasty, the patient had a visual acuity of 20/60 with mild neurotrophic keratopathy and irregular astigmatism. CONCLUSION: The use of intraocular air at the time of graft repositioning can induce posterior dislocation of an IOL in the setting of a YAG capsulotomy opening.