Pitfalls in Ophthalmology - DSAEK Mishap

By Anonymous

After doing my very first DSAEK in private practice, I was excited to see how my patient was doing the next day. After taking the patch off, I saw that the inferior 2/3 of the graft was slightly dislocated. Since I was at a satellite office without a procedure room with an operating microscope, I decided to inject air into the anterior chamber at the slit lamp (something I hadn't done before). When I did, air got into the interface and pushed the graft completely off. Great.
The patient and I then both drove 45 minutes to the main office, where in the procedure room I attempted to refloat the graft. For some reason, I decided to use a needle. I nicked the iris, causing a total hyphema. Sweet.

Then I set the patient up to go to the OR that night for an anterior chamber washout. By the time I got in there, the blood had completely clotted and couldn't be removed, especially from the interface. So I had to remove the graft and wash out as much heme as I could. Then we waited a few weeks for the hyphema to clear.

Thankfully, the next graft did great.