Spontaneous total Descemet's membrane detachment nine years after penetrating keratoplasty for keratoconus

Session Details

Session Title: Presented Poster Session: Spotlight on Cornea

Venue: Poster Village: Pod 2

First Author: : A.Vasquez Perez UK

Co Author(s): :    V. Kit   S. Tuft                    

Abstract Details

Purpose:

To describe a rare late complication of unknown aetiology in patients with history keratoconus and previous penetrating keratoplasty.  Possible mechanisms are discussed.

Setting:

Moorfields Eye Hospital London United Kingdom

Methods:

A patient presented with acute spontaneous total Descemets membrane detachment 9 years following penetrating keratoplasty. The case was initially managed as graft rejection until AS-OCT confirmed total DM detachment. Four cases only have been reported, however this is the earliest case of spontaneous DM detachment following PK for keratoconus in the literature.

Results:

Intracameral gas injection (SF6) was performed in order to reattach the DM but this approach was not successful. As the patient was phakic with known clear lens we decided to proceed with repeat PK instead of endothelial keratoplasty in order to avoid cataract development. The excised full thickness graft was sent to histopathology which revealed absence of fibrotic retrocorneal membranes on the peripheral Descemet but the presence of a small central break.

Conclusions:

Patients presenting with late sudden onset corneal oedema following PK for keratoconus with no signs of rejection, this aetiology should be considered and there should be a low threshold for performing AS-OCT to aid diagnosis. Although intracameral tamponade is shown to be effective in a few reported cases, further endothelial keratoplasty or repeat PK may be required specially if total DM detachment is present.

Financial Disclosure:

None