J Korean Ophthalmol Soc.  2014 Mar;55(3):449-453. 10.3341/jkos.2014.55.3.449.

A Case of Double Descemet's Membrane after Penetrating Keratoplasty Converted from Deep Anterior Lamellar Keratoplasty

• Im JC
• Kim HK
• Lee JH

• KMID: 2218278
• DOI: http://doi.org/10.3341/jkos.2014.55.3.449

Abstract

PURPOSE
To report a case of double Descemet's membrane in a patient who had penetrating keratoplasty after rupture of Descemet's membrane during deep anterior lamellar keratoplasty (DALK).
CASE SUMMARY
A 24-year-old female had keratoconus in her right eye and underwent DALK for treatment. Descemet's membrane was ruptured while separating the corneal stroma from Descemet's membrane with the big bubble technique. The operation method was changed from DALK to penetrating keratoplasty. Detached Descemet's membrane was observed in the anterior chamber after suturing. Sterile air was injected into the anterior chamber to attach the Descemet's membrane. Five days after the surgery, Descemet's membrane was detached and a second air injection was performed. Corneal edema was improved but Descemet's membrane was re-detached. Double Descemet's membrane was observed by anterior segment optical coherence tomography (OCT). The detached Descemet's membrane originated from the recipient's cornea and not from the donor's cornea. Detached Descemet's membrane was removed successfully. Patient's cornea was clear and best corrected visual acuity was 20/25.
CONCLUSIONS
When penetrating keratoplasty is performed instead of DALK, the surgeon should completely remove the remnant corneal stroma and Descemet's membrane. Remnant Descemet's membrane can be disregarded as it comes from the donor cornea. Unnecessary anterior chamber air injection causes endothelial damage. Anterior segment OCT is a useful tool to identify anatomical structures of transplanted cornea.

Keyword

Anterior segment OCT; DALK; Double Descemet's membrane; PKP

MeSH Terms

Anterior Chamber
Cornea
Corneal Edema
Corneal Stroma
Corneal Transplantation*
Descemet Membrane*
Female
Humans
Keratoconus
Keratoplasty, Penetrating*
Rupture
Tissue Donors
Tomography, Optical Coherence
Visual Acuity
Young Adult

Figure

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  Figure 1. (A) Big bubble technique to separate corneal stroma and Descemet’s membrane. (B) To convert to penetrating keratoplasty, remnant corneal tissue was removed. (C) After completing corneal sutures, detached Descemet’s membrane (white arrows) was observed. (D) Sterile air was injected to attach Descemet’s membrane.

• 

  Figure 2. (A) Postoperative slit-lamp photograph. Although the Descemet’s membrane was still detached (white arrow), the graft got clear. (B) Anterior segment OCT image showed that the detached Descemet’s membrane was originated not from donor but from recipient. (C) Double Descemet’s membrane was removed successfully.

Reference

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