Ischemic optic neuropathy after Descemet-stripping automated endothelial keratoplasty

An 82-year-old woman presented with a failed Descemet-stripping automated endothelial keratoplasty (DSAEK) in her right eye performed a month earlier. The patient underwent uneventful repeat DSAEK. Six days after the procedure, the patient was found to have an afferent pupillary defect and optic nerve swelling in her right eye on fundoscopy and optical coherence tomography. A comprehensive workup, including bilateral temporal artery biopsies and magnetic resonance imaging, for vasculitic etiologies was negative. A diagnosis of nonarteritic anterior ischemic optic neuropathy (NAION) was made. Although NAION has been reported after various ocular surgeries, to the authors' knowledge, this is the first reported case of NAION after uneventful corneal transplantation. Therefore, NAION should be considered a rare complication of corneal transplantation surgery. Meticulous preoperative and postoperative evaluation, including an attentive pupillary and dilated fundus examination, are essential in assessing a patient's risk factors for this condition and monitoring for its occurrence in the perioperative period.