AS-OCT Detection of Posterior Gas Bubble Dislocation After DSAEK Preventing Malignant Glaucoma

Descemet stripping automated endothelial keratoplasty (DSAEK) is a well-established surgical technique for the treatment of endothelial dysfunction, in which intracameral gas tamponade plays a critical role in graft adherence. We report a case of a patient with pseudophakic bullous keratopathy who underwent an uncom-plicated DSAEK procedure using a 25% sulfur hexafluoride (SF6) gas–air mixture. On the first postoperative day, slit-lamp examination suggested an appropriate anterior chamber configuration and satisfactory graft attachment. However, detailed anterior segment optical coherence tomography (AS-OCT) revealed subtle posterior migration of the gas bubble beneath the iris plane. This clinically occult finding raised concern for altered anterior segment anatomy and a potential risk of malignant glaucoma. Prompt surgical re-intervention was undertaken on postoperative day one, involving decompression of the misdirected gas bubble and reinjection of a centrally positioned tamponade. This resulted in restoration of normal anterior chamber configuration and stable graft adherence. Best-corrected visual acuity (BCVA) improved from 0.1 Snellen (1.0 logMAR) preope-ratively to 0.7 Snellen (0.15 logMAR) at 2 weeks following surgery. This case highlights the value of AS-OCT in detecting clinically unapparent postopera-tive complications after DSAEK, enabling timely intervention and prevention of po-tentially sight-threatening conditions.