Free Papers

Spontaneous Descemet's membrane detachment of penetrating keratoplasty grafts can mimic late graft failure

Free Paper Details

First Author: E.Livny ISRAEL

Co Author(s):    G. Melles   D. Israeli   Y. Nahum   J. Dadon   I. Bahar   O. Gal-or     

Abstract Details

Purpose:

Late penetrating keratoplasty (PKP) failure is a common finding in patients who underwent successful transplantation years back. This usually represents the natural demise of the transplanted endothelial cells and warrants re-transplantation of either PKP or posterior lamellar keratoplasty. However, rare event of spontaneous PKP graft Descemet's membrane detachment (with viable endothelial cells) can occur, which mimics late failure, and warrants proper diagnosis and treatment. We present our experience with four cases of this rare entity.

Setting:

Cases collected from the following centers: Rabin Medical Center (Israel) Carmel Medical Center (Israel) and Netherlands Institute for Innovative Ocular Surgery (NIIOS, the Netherlands)

Methods:

Presentation of a series of 4 patients who underwent PKP years back, who had recent vision deterioration and were primarily diagnosed as having late graft failure. Upon further meticulous work-up including anterior segment OCT, a spontaneous PKP graft Descemet's membrane detachment was detected. All patients underwent gas or air injection into the anterior chamber in order to re-attach the Descemet's membrane.

Results:

Three of 4 cases had a successful re-attachment of the Descemet's membrane following air/gas injection resulting in clearing of the PKP graft and regaining their base-line vision. In one case the Descemet 's membrane was already fibrotic and taught in time of diagnosis and did not reattach following gas injection into the anterior chamber, necessitating re-transplantation.

Conclusions:

Spontaneous PKP graft Descemet's membrane detachment can mimic late graft failure. Identification of this entity requires different diagnosis tools and possess different prognosis if treated properly. This entity is not well-known and sparsely reported in the literature. The comprehensive ophthalmologist should be familiar with this possibility and use an anterior segment-OCT in any case of suspected late PKP graft failure to rule out such an event, before deciding to proceed to re-grafting.

Financial Disclosure:

-