Refractory Recurrent Corneal Erosion after Descemet's Stripping Automated Endothelial Keratoplasty

Purpose: To report a case of refractory recurrent corneal erosion that occurred after Descemet's stripping automated endothelial keratoplasty (DSAEK) in iridocorneal endothelial syndrome. Case summary: A 62-year-old male patient with iridocorneal endothelial syndrome planned to undergo ultrathin DSAEK. At the surgery, corneal epithelial debridement was performed using a No. 15 blade to enhance the surgical field visibility. Three corneal venting incisions were made before graft insertion in the recipient eye. The corneal epithelium was healed at postoperative 1 week. However, the epithelium detached at 2 weeks postoperatively. The loosened epithelium was peeled off, and a therapeutic bandage contact lens was applied. Thereafter, the corneal epithelial detachment did not improve, despite repeated corneal epithelial debridement, prolonged therapeutic bandage contact lens wear, applications of 5% sodium chloride eyedrops and autoserum eyedrops, and intake of doxycycline, steroids, and valaciclovir. Anterior stromal puncture was performed three times, and the corneal epithelium eventually attached at postoperative 8 weeks. Although recurrent corneal erosion was not observed at postoperative 10 weeks, acute graft rejection occurred but improved with immunosuppressive treatment. The corrected visual acuity was 0.8 after cataract surgery, which was performed at 1 year after DSAEK. Conclusions: Refractory recurrent corneal erosion may occur after DSAEK surgery. In such a case, an aggressive treatment including the repeated anterior stromal puncture technique may be helpful.