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Ophthalmic Images
June 8, 2017

Descemet Membrane Splitting Following Deep Anterior Lamellar Keratoplasty

Author Affiliations
  • 1Tissue Engineering and Stem Cell Group, Singapore Eye Research Institute, Singapore, Singapore
  • 2Department of Ophthalmology, RWTH Aachen University, Aachen, Germany
  • 3Singapore National Eye Centre, Singapore, Singapore
  • 4Eye-ACP, Duke-NUS Graduate Medical School, Singapore, Singapore
  • 5School of Material Science and Engineering, Nanyang Technological University, Singapore, Singapore
JAMA Ophthalmol. 2017;135(6):e170656. doi:10.1001/jamaophthalmol.2017.0656

A woman in her 70s presented with a reduced visual acuity of 20/50 from a postinfectious scar in her right cornea. A deep anterior lamellar keratoplasty was performed with the Anwar big bubble technique.1 Intraoperatively, following the intrastromal air injection, 2 bubbles formed, one between the corneal stroma and a predescemetic layer (type 1) and the other between the predescemetic layer and the Descemet membrane (DM, type 2).2 A microperforation occurred during the suturing of the donor graft. Air was inserted into the anterior chamber as a tamponade. One day after surgery, an inferior DM detachment with a splitting of the predescemetic and DM layer was noted by slitlamp (Figure, A) and optical coherence tomography (Figure, B). The patient was “rebubbled,” and after additional air was injected into the anterior chamber, the patient was advised to remain in a supine position. The following day, the DM was reattached and the cleavage plane had disappeared. Her 1-year postoperative visual acuity improved to 20/32.

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