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PUBLICATION EXCLUSIVE: Man experiences painless vision loss after combined DSAEK, cataract surgery

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A 65-year-old Caucasian man was emergently referred to the retina department at the New England Eye Center for less than 24 hours of painless loss of vision in the right eye. He had undergone a combined Descemet’s stripping automated endothelial keratoplasty and cataract extraction in the right eye 6 days before presentation. His immediate postoperative period had been uncomplicated thus far.

The day of presentation, he returned to his surgeon’s office and was immediately referred to our retina department with concern for endophthalmitis. He had no other complaints. He had been seeing well the previous day and had been using his postoperative drops as directed. His ocular history was significant for Fuchs’ dystrophy in both eyes. His medical history was significant only for hyperlipidemia. He was currently using topical ketorolac, ofloxacin, prednisolone and brimonidine in the right eye. His oral medications included pravastatin and aspirin. He did not use tobacco or alcohol, and he did not have known drug allergies.

Examination

On exam, best corrected distance visual acuity was 20/200 in the right eye and 20/25 in the left eye. Both pupils were equally reactive to light with no afferent pupillary defect. Extraocular motility and confrontational visual fields were full in both eyes. IOP was 17 mm Hg in the right eye. The anterior segment exam of the right eye was significant for an attached DSAEK graft centrally but the nasal edge of the graft was curled downward. There were 1+ microcystic edema, 1+ stromal edema and 1+ Descemet’s folds present. There was also a possible fibrin deposit or infiltrate that was visible on the inferior edge of the graft. In the anterior chamber, 4+ cell was present along with a 1-mm hypopyon. The posterior segment exam revealed 2+ vitreous cell, but the fundus was otherwise unremarkable. The exam of the left eye was unremarkable.

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• Click here to read the full publication exclusive, Grand Rounds at the New England Eye Center, published in Ocular Surgery News U.S. Edition, July 10, 2017.