Silicone Oil Migration into the Graft Interface after Descemet Stripping Automated Endothelial Keratoplasty in a Patient with a Past Surgical History of Silicone Oil Tamponade: A Case Report

Introduction: Descemet stripping automated endothelial keratoplasty (DSAEK) is widely accepted as an alternative to penetrating keratoplasty for the treatment of corneal endothelial failure. Surgical outcomes, however, may be compromised in eyes with complex surgical histories, particularly following vitreoretinal procedures. We describe a case of silicone oil deposition at the donor-recipient interface after DSAEK in a patient with prior silicone oil tamponade. Case Presentation: A 42-year-old man with pseudophakic bullous keratopathy previously underwent traumatic cataract surgery, pars plana vitrectomy with silicone oil injection, subsequent oil removal, and implantation of an angle-supported anterior chamber intraocular lens. He later underwent anterior chamber lens explantation, Artisan iris-claw lens implantation, and DSAEK. By postoperative day 9, multiple silicone oil droplets were observed at the donor-recipient interface, with a further increase in size and number by day 14. An anterior chamber washout was performed; however, droplets persisted at the surgical interface. Conclusion: This case highlights the risk of silicone oil entrapment at the DSAEK donor-recipient interface in eyes with prior vitreoretinal surgery and silicone oil tamponade. Thorough removal of residual silicone oil before donor lenticule insertion is essential to minimize interface-related complications.