‘Computer mouse sign’ may predict inverted endothelial graft

Corneal endothelial decompensation has been treated successfully by endothelial keratoplasty techniques. Intrinsic properties of the host and multiple factors in the graft play a role in graft adherence. Graft detachments and positional problems are often detected clinically or by anterior segment OCT. Although OCT has been used for analysis of the graft, there have been no clear patterns described for detachments or inverted grafts. We have described a unique configuration in the form of a computer mouse that is seen in patients with a tight scroll, which often is difficult to unroll and requires graft removal.“Mouse sign” is described in relation to the configuration of a computer mouse. This sign is seen only by OCT, preferably by spectral or Fourier domain OCT. Spectral domain OCT has a resolution of 5 µm and shows a clear pattern with an endothelial graft. We used Cirrus 5000 spectral domain OCT (Carl Zeiss Meditec) to examine postoperative patients after pre-Descemet’s endothelial keratoplasty. Fourier domain OCT showed a detached graft involving the partial central and inferior cornea with the convex configuration (Figure 1) and one end still attached to the cornea like a “computer mouse.” The partial attachment of the graft and the end scroll give the mouse configuration. We noticed such a pattern in five eyes of patients who underwent PDEK and seemed to have an inverted graft. All five patients had unsuccessful re-bubbling and had graft exchanges.