Surgical management of spontaneous, late-onset Descemet membrane detachment after penetrating keratoplasty for keratoconus: a case report

Abstract

BackgroundTo report a surgical method for treating corneal oedema in a case of late-onset Descemet membrane detachment after penetrating keratoplasty.Case presentationA 55-year old patient presented with sudden visual loss in his left eye 28 years after penetrating keratoplasty for keratoconus. Slit-lamp biomicroscopy revealed a distortion of the corneal graft anatomy with protrusion of the graft and peripheral thinning and steepening in the residual host tissue, accompanied by corneal graft oedema. Anterior segment optical coherence tomography revealed detachment of Descemet membrane localized to the area of the graft oedema. We proceeded with a full-thickness, partially circumferential incision in the graft-host junction, followed by repositioning and re-suturing of the graft in place, and intracameral air injection in order to achieve reattachment of Descemet membrane.ConclusionsCorneal graft repositioning in combination with re-bubbling may represent an effective therapeutic option in keratoconic patients with peripheral thinning in the residual host corneal tissue and subsequent Descemet membrane detachment.

Descemet Membrane Detachment After Penetrating Keratoplasty for Keratoconus

“…11 However, the DM reattached in one eye following a 270 o full thickness wound revision with gas tamponade. 8 Finally, two eyes had a PK and a three eyes had a DSAEK.…”

“…Late-onset Descemet membrane (DM) detachment has also been described. [7][8][9][10][11] We report an additional seven eyes that developed an acute DM detachment several years after a PK for keratoconus, including an individual with bilateral detachments, and one case that resolved spontaneously. DM detachment was identified at slit lamp examination and confirmed with anterior segment optical computerized tomography (AS-OCT, Casia2, Tomey Corporation, Japan).…”

Late detachment of Descemet's membrane after penetrating keratoplasty for pellucid marginal degeneration

“…This results in sudden cornea edema that can be mistaken for acute graft rejection. This has been reported in several cases of recurrent keratoconus but not in recurrent pellucid marginal degeneration 3, 4, 5, 6. Here we report a case of spontaneous Descemet's membrane detachment in recurrent pellucid marginal degeneration.…”

“…This has been reported in several cases of recurrent keratoconus but not in recurrent pellucid marginal degeneration. 3 , 4 , 5 , 6 Here we report a case of spontaneous Descemet's membrane detachment in recurrent pellucid marginal degeneration. The case also reports the use of the Prosthetic Replacement of Ocular Surface Environment (PROSE, Boston Foundation for Sight, Needham, MA) scleral contact lens for recurrent pellucid marginal degeneration and the success of DSAEK in a very steep cornea.…”

Optical coherence tomography imaging in keratoconus

“…OCT has led to the diagnosis of late Descemet's membrane detachment many years after a PK for keratoconus, in cases presenting with sudden onset of corneal oedema which may mistakenly be diagnosed as endothelial rejection or graft failure. In such cases, rebubbling of the Descemet's membrane with air in the anterior chamber can lead to clearing of the cornea without the need for a further transplant …”