Air migration behind iris after DSEK linked to secondary angle closure, IOP spike

Cornea. 2009;28(6):652-656.

Air migration behind the iris after Descemet's stripping endothelial keratoplasty was associated with secondary angle closure, a study showed.

"An acute increase in IOP after DSEK can also be induced by air anterior to the iris causing pupillary block," the study authors said. "IOP spikes are much more common in the first few postoperative days after DSEK."

The retrospective case series included 100 eyes of 90 patients who underwent DSEK indicated for Fuchs' dystrophy, pseudophakic bullous keratopathy, aphakic bullous keratopathy or iridocorneal endothelial syndrome.

Investigators performed slit lamp examinations and IOP measurements preop and postop. Primary outcome measures were preop and postop IOP.

Study data showed an increase in IOP of more than 30 mm Hg on postop day 1 in 13 eyes. Of those patients, six patients developed angle closure and iridocorneal adhesions from air migrating behind the iris, one patient developed pupillary block, and six patients developed increased IOP without pupillary block or iridocorneal adhesion. The latter group of patients also had a history of primary or secondary glaucoma.

"Medical treatment can occasionally resolve air posterior to the iris, but if iridocorneal adhesions are extensive and persistent, air removal and angle reformation may be necessary," the authors said.