An artifact of ultrawide-field retinal imaging due to DSAEK graft marking

Abstract

An 82-year-old woman with a history of Fuchs endothelial corneal dystrophy status post Descemet stripping automated endothelial keratoplasty (DSAEK) graft in the left eye was referred to Monmouth Retina Consultants for cystoid macular edema following cataract surgery. On pseudocolor ultrawide-field retinal imaging (Optos UWF) of the right eye a large letter “S” artifact overlying the nasal retina was noted (A). The artifact was also seen on fundus autofluorescence (B). On the slit-lamp examination of the patient’s right eye, the “S” marking was visible on the temporal side of the graft, which was the source of the observed artifact (C). The patient was asymptomatic, and the same letter “S” appearance was not appreciable on a clinical funduscopic examination. During standard endothelial grafting procedures, corneal surgeons typically label the graft’s endothelial surface with a letter using permanent violet marking pen, which helps ensure correct graft orientation.