Partial Descemet’s Membrane Overlap due to Previously Grafted Descemet’s Membrane Remnant: Case Report

Abstract

Abstract Background: This study aimed to describe the clinical outcomes of a patient who underwent repeated Descemet’s membrane endothelial keratoplasty (DMEK) on partially remaining Descemet’s membrane (DM) due to firm adhesion. Case presentation: A 78-year old female experienced vision fluctuations due to corneal edema after DMEK approximately 5 years ago. As scarring of the stroma was minimal, repeated DMEK was planned. The previously grafted DM was firmly attached to the posterior stroma in the inferior half area and could not be completely removed. After the donor lenticule was injected into the anterior chamber and unscrolled, room air was injected and the operation was completed. Two weeks postoperatively, focal detachment was observed at the border of the remnant DM. Focal DM detachment completely resolved without additional procedures 6 weeks postoperatively. At 5 months after surgery, the new DM was well attached, but overlap of the DM was identified on anterior segment OCT and Scheimpflug imaging. In addition, significant posterior astigmatism remained due to the overlap of the DM. Conclusions: Partially remaining DM disturbed the adhesion of the new DM at the border of the remnant. Despite the extremely thin thickness of lenticule, the overlapped DM induced significant posterior astigmatism.