Descemet Membrane Endothelial Keratoplasty for corneal decompensation due to migrating metallic intracorneal foreign bodies in an aphakic eye following a 39-year-old blast injury: A case report

PURPOSE: To report the use of Descemet Membrane Endothelial Keratoplasty (DMEK) for secondary surgical removal of intraocular foreign bodies (IOFB) years after the trauma as migration occurred through the endothelium, damaging the endothelium, and causing corneal edema. OBSERVATIONS: We report the case of a blast injury in 1972, that led to left eye traumatic cataract managed with vitrectomy and lensectomy. Although thorough removal was attempted, some corneal and conjunctival foreign bodies remained. Despite aphakia, the patient maintained acceptable best corrected visual acuity (BCVA) (0.30 LogMAR) but >30 years later, experienced visual deterioration. IOFB protruding through the Descemet membrane (DM) were seen, with extensive edema. Descemet Membrane Endothelial Keratoplasty was performed in an attempt to treat the endothelium and remove the foreign bodies protruding through the DM. The procedure was done uneventfully under sulfur hexafluoride gas (SF6) and the patient improved. Four years after the surgery, BCVA was 0.63, however, 6 years later, a new episode of migrating intracorneal foreign bodies with corneal edema reduced BCVA to 0.40. The decision was made to observe the patient, and delay a second DMEK. CONCLUSIONS AND IMPORTANCE: Corneal decompensation caused by IOFB breaching the Descemet membrane can safely be managed with a DMEK. DMEK is feasible even in complex cases and should be attempted due to its lower risk of graft rejection and likely benefits, while saving the option of more aggressive transplantation techniques, such as penetrating keratoplasty, in cases of failure.