Secondary angle closure caused by air migrating behind the pupil in descemet stripping endothelial keratoplasty

Jung S. Lee, Neel R. Desai, Gregory W. Schmidt, Albert S. Jun, Oliver D. Schein, Walter J. Stark, Allen O. Eghrari, John D. Gottsch

Research output: Contribution to journalArticlepeer-review

41 Scopus citations


PURPOSE: To report secondary angle closure caused by air migrating behind the pupil in the context of intraocular pressure (IOP) elevation in the early postoperative period after Descemet stripping endothelial keratoplasty (DSEK). METHODS: A retrospective case series was conducted on 100 consecutive DSEK cases from 90 patients undergoing DSEK because of corneal disease from Fuchs corneal dystrophy, pseudophakic bullous keratopathy, aphakic bullous keratopathy, and iridocorneal endothelial syndrome. Preoperative and postoperative slit-lamp examinations and IOP measurements were ascertained for all 100 eyes. Main outcome measures included preoperative and postoperative IOP. RESULTS: Thirteen of 100 eyes developed an IOP rise of greater than 30 mm Hg on the first postoperative day. Six of these 13 patients developed angle closure from air migrating posterior to the iris and causing iridocorneal adhesions. One of these 13 patients developed pupillary block from air anterior to iris. Six of 13 patients developed increased IOP without pupillary block or iridocorneal adhesions and had a history of preexisting primary or secondary glaucoma. CONCLUSIONS: A secondary angle closure associated with DSEK is reported with air migrating behind the iris, resulting in extensive iridocorneal adhesions. An acute increase in IOP after DSEK can also be induced by air anterior to the iris causing pupillary block. IOP spikes are much more common in the first few postoperative days after DSEK. Medical treatment can occasionally resolve air posterior to the iris, but if iridocorneal adhesions are extensive and persistent, air removal and angle reformation may be necessary.

Original languageEnglish (US)
Pages (from-to)652-656
Number of pages5
Issue number6
StatePublished - Jul 2009


  • DSEK
  • Iridocorneal adhesions
  • Secondary angle closure

ASJC Scopus subject areas

  • Ophthalmology


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