# Posterior Migration of a Descemet Membrane Endothelial Keratoplasty Graft Associated With Macular Proliferative Changes

## TL;DR

A rare complication of DMEK surgery is described where the graft migrated to the vitreous cavity and caused macular changes.

## Contribution

This case highlights a rare posterior migration of a DMEK graft and its association with macular proliferative changes.

## Key findings

- The DMEK graft was lost during surgery and later found in the vitreous cavity.
- Fibrovascular proliferation was observed in association with the migrated graft.
- Successful removal of the graft was achieved through pars plana vitrectomy.

## Abstract

A 79-year-old male underwent descemet membrane endothelial keratoplasty (DMEK) for bullous keratopathy. Intraoperatively, the intraocular lens (IOL) became unstable during graft manipulation, and the graft was lost from the anterior chamber. Postoperative examination failed to identify the graft. Two weeks later, optical coherence tomography (OCT) showed macular proliferative changes without hemorrhage or peripheral ischemia. Subsequent pars plana vitrectomy revealed the DMEK graft in the vitreous cavity, associated with fibrovascular proliferation. The graft was successfully removed. This case demonstrates a rare complication of DMEK and emphasizes the need for vigilance in eyes with compromised posterior capsule or zonules.