Purposewe report a case of late spontaneous large detachment of Descemet's membrane in recurrent pellucid marginal degeneration after penetrating keratoplasty.Observationsa 73-year-old man presented to clinic with spontaneous detachment of his Descemet's membrane 30 years after penetrating keratoplasty for pellucid marginal degeneration. Efforts were made to bubble the membrane back into place without success. The patient then underwent endothelial keratoplasty with successful restoration of cornea clarity.Conclusions and importancethis condition may cause diagnostic and treatment dilemmas if not properly identified and managed. In addition this case has information for both the use of scleral contact lens and the success of endothelial keratoplasty in an extremely steep cornea.

IntroductionThis study is a retrospective case series to evaluate the outcomes and complications of Baerveldt glaucoma implant surgery (BGI) in patients without prior cataract or incisional glaucoma surgery.MethodsPatients who underwent 350-mm2 BGI through the Glaucoma Service of the University of Illinois at Chicago between 2010 and 2015 were included in this study. Outcome measures included age, sex, ethnicity, operated eye, preoperative diagnosis, preoperative, and sequential postoperative intraocular pressure (IOP), visual acuity, glaucoma medications, and postoperative complication and interventions. Statistical analyses were performed using the two-sided Student t test for continuous variables.ResultsThirty-seven patients were studied. IOP was consistently and statistically significantly lower at 3 months (17.4 ± 6.4, p = 3 × 10−7), 6 months (13.9 ± 5.1, p = 2 × 10−11), 1 year (12.2 ± 4.0, p = 9 × 10−10), and 2 years (14.6 ± 3.3, p = 0.0004) postoperatively compared to IOP at baseline (27.5 ± 8.1). Fewer glaucoma medications were used at 3 months (2.8 ± 1.3, p = 0.04), 6 months (2.6 ± 1.2, p = 0.02), 1 year (2.7 ± 1.7, p = 0.04), and 2 years (2.0 ± 1.2, p = 0.03) postoperatively compared to baseline (3.4 ± 1.1). A total of six cases (16%) had failure. A total of five patients (15%) had postoperative complications. Mean Snellen visual acuity was not statistically different at 6 months (0.5 ± 0.6, p = 0.88) or 1 year (0.4 ± 0.4, p = 0.57) postoperatively from baseline (0.5 ± 0.6).ConclusionsPrimary BGI is effective at reducing IOP and the medication burden in patients suffering glaucomatous optic neuropathy. Further randomized prospective studies are needed to compare various procedures in the primary surgical management of patients with uncontrolled glaucoma.FundingThis study was funded by an unrestricted grant from Research to Prevent Blindness.