Eyeworld

68 | EYEWORLD | DECEMBER 2021 C ORNEA Contact Lin: amylin78@gmail.com Price: fprice@pricevisiongroup.net Relevant disclosures Lin: None Price: None patient sits up, it could go to the back of the eye. In some of these patients, you might want to consider DSAEK, he said. Additionally, in patients with filters, espe- cially tube shunts, there is an opening that the air can go up into. If it's an inferior tube, this might not be a big deal, Dr. Price said, but if it's a superior tube, you may have to either put in a reinjection of air once the air goes up in order to fill the anterior chamber or try long-acting gas. Another problem with filters, he said, is the air can block the filter and pressure can shoot up in the eye. He makes sure to tell patients not to rub or push on the eyes because that will cause a de- tachment. While detachments can occur during surgery, generally, it is a postop complication. Dr. Price noted that it's important to be careful during surgery if you have a case of an artificial iris. If you're looking through a co- axial microscope, you get the impression you have a normal angle, which you don't because there's nothing in the angle, he said. The angle area goes out 12–13 mm, and artificial irises are typically 9–11 mm in diameter. If you put a DSAEK graft into one of those eyes and let go before putting an air bubble under it, it can fall into the back of the eye because it never got attached, he said. But generally during surgery, you shouldn't get a detachment once you've filled the anterior chamber with air. Dr. Lin also highlighted considerations for patients with comorbidities or previous sur- geries. She mentioned that she has found a higher rate of graft detachments with DSAEK in patients with comorbidities such as tube shunts, trabeculectomies, aphakia, or iris defects and anterior synechiae. With trabeculectomy and tubes, the air tends to escape faster than nor- mal. If the patient has had a prior trabeculec- tomy or tube shunt, Dr. Lin will leave a much larger air bubble in the eye, maybe 90–100% air fill rather than the 80% she typically uses. Dr. Lin said she will discuss the potential problem of detachment with patients preopera- tively. "I tell them that if it should happen, I can typically rebubble the graft in the office, or if that doesn't work, we could do it in the OR, or worst case, repeat the transplant," she said. OCT of near total detachment; note the way the graft is curled on the right side; it curls endothelium out so this is positioned the correct way, and reinjecting air should push it into place Source: Francis Price Jr., MD continued from page 67

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