Corneal Endothelial Graft Failure After Endoscopic Cyclophotocoagulation: A Case Report

We report a case of corneal endothelial graft failure that developed after endoscopic cyclophotocoagulation (ECP) for elevated intraocular pressure (IOP) following Descemet's stripping automated endothelial keratoplasty (DSAEK). The patient was a 69-year-old Japanese woman with primary angle-closure glaucoma who had undergone phacoemulsification with intraocular lens implantation and goniosynechialysis for peripheral anterior synechiae (PAS), followed by trabeculectomy, repeat bleb revisions, Baerveldt glaucoma implant surgery, and Ahmed glaucoma valve implantation with tube insertion into the anterior chamber in the past two years. Subsequently, she developed bullous keratopathy, and the first DSAEK was performed in July 2020. Subsequently, iris adhesion and atrophy progressed around the tube, and PAS became severe, resulting in graft failure. A second DSAEK combined with pupilloplasty was performed in November 2021, after which the graft transparency was maintained. Since March 2022, IOP has increased despite treatment with maximum medication; therefore, ECP was performed to reduce IOP in September 2022. IOP decreased after ECP; however, the patient developed graft failure within a few months. A third DSAEK was performed in July 2023. In conclusion, for eyes with borderline corneal endothelial cell decompensation, the indications for ECP should be decided with caution.