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Matthew Gorski, Ira J Udell; Spontaneous Descemet’s Membrane Detachment 20 Years after Penetrating Keratoplasty for Keratoconus. Invest. Ophthalmol. Vis. Sci. 2015;56(7 ):1560.
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To report two cases of spontaneous Descemet’s membrane (DM) detachment 20 years after penetrating keratoplasty for keratoconus.
A retrospective chart review of two patients was performed.
Two male patients—ages 59 and 50— presented 21 and 25 years, respectively, after uncomplicated penetrating keratoplasty for keratoconus, complaining of foreign body sensation. Best corrected vision was 20/40 and 20/30, respectively. For both patients, slit lamp examination revealed peripheral corneal thinning and steepening on the host, temporal peripheral microcystic edema on the graft without any sign of rejection, quiet anterior chamber, and mild nuclear sclerotic cataract. Subsequent anterior segment optical coherence topography (OCT) demonstrated a DM detachment localized to the area of the cornea edema (Figure 1). One patient’s DM failed to re-attach after anterior chamber air injection and then underwent successful Descemet’s stripping automated endothelial keratoplasty (DSAEK) with resultant best corrected vision of 20/20. The other patient had failed mechanical incision at the graft-host interface with air injection for possible retrocorneal membrane and is considering further keratoplasty options.
Spontaneous DM detachment more than two decades after uncomplicated penetrating keratoplasty for keratoconus is a previously unrecognized entity. Novel imaging modalities like anterior segment OCT should be utilized to identify this clinically difficult to detect etiology of microcystic corneal edema. The cause of DM detachment is unclear, but may be due to mechanical forces from a retrocorneal membrane or from progressive keratoconus leading to peripheral host corneal steepening and thinning.
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