Post DSAEK with Air in AC

The following case is that of a patient about 2 hour after her Descemet Stripping Automated Endothelial Keratoplasty (DSAEK or DSEK).  The DSEK was successful however the corneal edema poses interesting challenges to all the different technologies of the Visante, Pentacam, and the Cirrus.

Immediately after Descemet Stripping Endothelial Keratoplasty with air bubble in the anterior chamber

The Visante image (1310 nm light source) above shows the corneal button is perfectly attached with differential thickness.  This thickness variation is significantly reduced as the edema within the inserted lamellae is reduced.  The image is acquired in the enhanced anterior segment image mode 16mm by 6mm.  The full width of the anterior chamber is seen.  The angles are clear.  The posterior displacement of the iris and the lens complex is clearly noted.  Very little to no true distortions of the image is induced by the air in the anterior chamber.  Interestingly enough, the air is not seen by the Visante.

Immediately after Descemet Stripping Endothelial Keratoplasty (DSEK) with Air still in the Anterior Chamber

The Scheimpflug image from Pentacam (475nm light source) for the same eye is seen here.  The corneal edema and the air bubble cause a tremendous amount of "noise."  Since the 475nm light is visible, it gets reflected back trough the posterior side of the air bubble and created much of the noise.  in addition, although, the DSEK button can be seen, the details are meager.  The Air bubble interface behind the DSEK button is noted in some parts.  The view of the iris and the lens complex is non-existent.

Cirrus OCT image of a cornea after DSEK

The Cirrus OCT (840nm light source) image of the same eye after DSEK with Air in the AC.  The corneal edema is seen in the spectral domain with exquisite detail, and the air in the anterior chamber is clearly noted.  Even a small epithelial microcyst can be seem at the left side of the image as a small black dot in the epithelium.  The DSEK interface is clearly visible.