Descemet’s Stripping Automated Endothelial Keratoplasty (DSAEK) Management of Bullous Keratopathy After PreserFlo MicroShunt Device: A Case Report and Literature Review

Bullous keratopathy is a known complication following glaucoma filtration surgeries, and Descemet's stripping automated endothelial keratoplasty (DSAEK) has been reported as an effective management approach in several cases. However, management of bullous keratopathy in eyes with minimally invasive bleb surgery (MIBS) devices presents unique challenges. We report the first successful case of DSAEK in a patient with bullous keratopathy following PreserFlo MicroShunt (PMS) (Santen Pharmaceutical Co., Ltd., Osaka, Japan) implantation, with additional complications of prior vitrectomy for malignant glaucoma. The patient, a 69-year-old male, had undergone bilateral pseudoexfoliative glaucoma surgery, and subsequent DSAEK was performed, resulting in favorable postoperative outcomes despite the challenging presentation. This case demonstrates the feasibility of endothelial keratoplasty in eyes with PreserFlo devices and crucial insights for surgical management, including our modified technique with limited central Descemet's membrane stripping, shortening of the PMS device, and utilization of a thinner donor graft to overcome the unique challenges associated with glaucoma drainage devices.