Surgical management of spontaneous, late-onset Descemet membrane detachment after penetrating keratoplasty for keratoconus: a case report

BACKGROUND: To report a surgical method for treating corneal oedema in a case of late-onset Descemet membrane detachment after penetrating keratoplasty. CASE PRESENTATION: A 55-year old patient presented with sudden visual loss in his left eye 28 years after penetrating keratoplasty for keratoconus. Slit-lamp biomicroscopy revealed a distortion of the corneal graft anatomy with protrusion of the graft and peripheral thinning and steepening in the residual host tissue, accompanied by corneal graft oedema. Anterior segment optical coherence tomography revealed detachment of Descemet membrane localized to the area of the graft oedema. We proceeded with a full-thickness, partially circumferential incision in the graft-host junction, followed by repositioning and re-suturing of the graft in place, and intracameral air injection in order to achieve reattachment of Descemet membrane. CONCLUSIONS: Corneal graft repositioning in combination with re-bubbling may represent an effective therapeutic option in keratoconic patients with peripheral thinning in the residual host corneal tissue and subsequent Descemet membrane detachment.