Supplementary Material for: A Case of Transparent Cornea Maintained After Removal of Dislocated Graft from Descemet’s Stripping Automated Endothelial Keratoplasty

Introduction
Corneal graft detachment is a major postoperative complication of Descemet’s stripping automated endothelial keratoplasty (DSAEK). When a corneal graft becomes detached, corneal endothelial function generally fails, and repeat corneal transplantation is required. Herein, we report a rare case in which a transparent cornea was maintained after the removal of a dislocated DSAEK graft.
Case Presentation
A 79-year-old woman with a residual lens cortex who had undergone cataract surgery was referred to our hospital. The cortex was removed, and bullous keratopathy progressed. Six months after the initial surgery, DSAEK was performed under topical anesthesia without any complications. Although the corneal graft had attached fairly well, it detached from the host cornea 3 weeks later. Two months after DSAEK, an air tamponade was used to treat the anterior chamber with single interrupted suturing; however, the graft detached again, except for the suture site. Because the detached cornea became cloudy in the anterior chamber, it was surgically removed 8 months after DSAEK. Accordingly, the host cornea transparency improved to a best-corrected visual acuity of 0.8 with a rigid gas permeable lens and a central corneal thickness of 580 μm. The corneal endothelial cell density was 995 cells/mm2.
Conclusion
Removal of the corneal graft from the dislocated cloudy graft improved the visual acuity of this patient after DSAEK. The condition of the cornea should be carefully monitored after corneal endothelial transplantation, even after the graft has been dislocated.

引言
角膜植片脱离是后弹力层剥除自动角膜内皮移植术（Descemet’s stripping automated endothelial keratoplasty, DSAEK）的主要术后并发症。当角膜植片发生脱离时，角膜内皮功能通常会受损，需再次行角膜移植手术。本文报告1例罕见病例：脱位的DSAEK植片摘除后，患眼仍维持了角膜透明性。

病例报告
1例曾接受白内障手术、残留晶状体皮质的79岁女性患者转诊至我院。术中摘除残留皮质后，患者出现大泡性角膜病变（bullous keratopathy）并进行性加重。初次手术后6个月，患者在表面麻醉下行DSAEK手术，手术过程顺利。尽管初期植片贴合良好，但术后3周植片脱离宿主角膜。DSAEK术后2个月，予前房空气填充术（air tamponade）联合间断单针缝合治疗，但除缝合固定处外，植片再次脱离。因脱离的植片导致前房角膜混浊，遂于DSAEK术后8个月手术摘除脱离的植片。术后患者佩戴硬性透气性角膜接触镜（rigid gas permeable lens），最佳矫正视力达0.8，中央角膜厚度为580μm，角膜内皮细胞密度（corneal endothelial cell density）为995个/mm²。

结论
本次病例显示，摘除脱位混浊的角膜植片可改善DSAEK术后患者的视力。角膜内皮移植术后需密切监测角膜状态，即便植片已发生脱位。