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Descemet Membrane Detachment After Penetrating Keratoplasty for Keratoconus.

Authors
  • Kit, Vivienne1
  • Kriman, Jaime1
  • Vasquez-Perez, Alfonso1
  • Muthusamy, Kirithika1
  • Thaung, Caroline2
  • Tuft, Stephen1
  • 1 Corneal Service, Moorfields Eye Hospital, London, United Kingdom. , (United Kingdom)
  • 2 Department of Pathology, UCL Institute of Ophthalmology, London, United Kingdom. , (United Kingdom)
Type
Published Article
Journal
Cornea
Publication Date
Oct 01, 2020
Volume
39
Issue
10
Pages
1315–1320
Identifiers
DOI: 10.1097/ICO.0000000000002352
PMID: 32384301
Source
Medline
Language
English
License
Unknown

Abstract

To describe the risk factors, management, and outcome of delayed Descemet membrane (DM) detachment after penetrating keratoplasty (PK) for keratoconus. We report 7 eyes from 6 cases and combine these data with 7 previous case reports identified by a search of PubMed. DM detachment occurred at a median of 25 years (range, 7-33 years) after PK. One individual had bilateral detachments. There was typically a mild ocular discomfort accompanied in some cases by a rapid onset of visual blur. Cases were often treated for allograft rejection before a DM detachment was suspected and confirmed by optical coherence tomography. Detachments were limited to the donor tissue in 11 eyes, but a DM break was identified at the time of onset in only 4 eyes. Thinning of the host corneal rim with ectasia was reported in 8 eyes (57%). In 3 eyes, the detachment resolved spontaneously, but in 2 eyes, a detachment was still present at 12 months. Gas tamponade to reattach the DM was performed in 9 eyes and was effective in 4 eyes. Five eyes underwent a repeat PK or endothelial keratoplasty. Histology showed fibroblastic proliferation on the stromal surface of the folded DM. The cause for DM detachment many years after PK is unknown, although progressive thinning of the host cornea and secondary graft ectasia may be implicated. Gas tamponade can be effective, but a repeat keratoplasty might be necessary. DM detachment should be included in the differential diagnosis for late-onset corneal edema after PK.

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