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Postoperative Trendelenburg Position for Graft Adherence After Descemet Stripping Automated Endothelial Keratoplasty

Belkin, Avner MD; Nesher, Ronit MD; Segev, Fani MD

doi: 10.1097/ICO.0b013e31829eeafb
Case Report

Purpose: To present a case of repeated graft dislocation after Descemet stripping automated endothelial keratoplasty (DSAEK) in a post-trabeculectomy eye and to suggest a simple postoperative maneuver to minimize this occurrence.

Methods: A 61-year-old woman presented to our cornea clinic with pseudophakic bullous keratopathy in her left eye 13 years after a trabeculectomy had been performed. After the DSAEK was performed, repeated graft dislocations were observed. When air was seen in the filtering bleb in the immediate postoperative period, it was assumed that it had escaped from the air bubble remaining in the anterior chamber at the end of the surgery. The patient was thus placed in the Trendelenburg position immediately after performing a rebubbling procedure to retain the air bubble in the anterior chamber and away from the filtering bleb.

Results: The corneal graft remained centered and clear at postoperative day 1 and remained so at the last follow-up visit 8 months after the surgery had taken place. The patient's intraocular pressure was well controlled with a functional filtering bleb.

Conclusions: Postoperative Trendelenburg positioning is an easily applied maneuver that may promote graft adherence after performing a DSAEK in eyes that have undergone glaucoma surgery.

*Department of Ophthalmology, Meir Medical Center, Kfar Saba, Israel; and

Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.

Reprints: Fani Segev, Department of Ophthalmology, Meir Medical Center, 44281 Kfar Saba, Israel (e-mail:

The authors have no funding or conflicts of interest to disclose.

Received May 09, 2013

Accepted June 03, 2013

Copyright © 2013 Wolters Kluwer Health, Inc. All rights reserved.