case_images: PMC9627103_01
case_images: (A, B) Slit lamp image of the right eye at presentation depicting corneal edema with Descemet membrane folds and peripheral bullae which are also visible on the optical coherence tomography scan (OCT).. (
  C, D) Image captured one month after the Descemet stripping automated endothelial keratoplasty (DSAEK) showing primary graft failure with a well attached graft. (E, F) Clear cornea with an attached DSAEK lenticule 2 weeks after the repeat endothelial keratoplasty.
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case_images: Slit lamp examination revealed an edematous cornea with epithelial bullae in the periphery ( Figure 1). Postoperatively the visual acuity was counting fingers and the graft was edematous but well attached on the optical coherence tomography (OCT) scan ( Figure 1). Figure 1). Figure 3 details the timeline of the patient from presentation to the last follow up.
case_images: (A, B) Schematic image and the corresponding clinical picture of the inverted lenticule showing the longer endothelial side (blue line, pink arrow) towards the host stroma which has the irregular donor stromal surface (red line, yellow arrow) facing the anterior chamber. The graft is forming an obtuse angle with the host cornea. (C, D) Graft attached in its correct orientation with the endothelial side facing the anterior chamber with its edge extending beyond the edge of the stromal surface (black and pink arrows). The compact graft has an acute angle at the edge interface with the host stroma.
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case_images: Figure 2). Furthermore, the irregular donor stromal surface facing the anterior chamber was also observed ( Figure 2). The correct apposition and orientation of the graft was confirmed on OCT ( Figure 2).
case_images: Timeline of the patient from presentation to the last follow up with details of the clinical features, interventions, and outcomes.. SICS: small incision cataract surgery, PCIOL: posterior chamber interocular lens, DSAEK: Descemet stripping automated endothelial keratoplasty, OCT: optical coherence tomography, VA: visual acuity.
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case_images: Figure 1). Figure 3 details the timeline of the patient from presentation to the last follow up.