Retained Descemet’S Membrane In Patient With Climatic Droplet Keratopathy (Cdk) After Penetrating Keratoplasty (Pkp) - A Case Report.

To report a case of retained Descemet’s membrane following penetrating keratoplasty (PKP) in a patient with climatic droplet keratopathy (CDK).

A case report of a 74-year-old male known to have CKD. He underwent a PKP surgery in the right eye secondary to corneal decompensation and thinning after superficial keratectomy. Postoperative review showed a retro-corneal membrane within the anterior chamber. Membranectomy with neodymium-dpoed yttrium alumnium garnet (Nd:YAG) laser was performed and patient’s vision improved from 20/400 to 200/100.

A 74 years old male case of diabetes mellitus, with a history of CDK, in 2016  he underwent phacoemulsification and posterior chamber intraocular lens implantation for significant posterior subcapsular cataract in his right eye. He also underwent a superficial lamellar keratectomy for ocular surface optimization to improve his visual outcome.  Inferior corneal scarring with significant thinning was observed 1 year postoperatively, which worsened in the subsequent follow up visits to include a small area 2 mm of  90% thinning but without any perforation and intact epithelium. 4 years after the cataract surgery due to loss of follow up, PKP for the right eye was indicated to excise all the thinning area. On the first postoperative day, a thin, transparent, and avascular membrane behind the graft was observed, manifested as duplication of the anterior chamber. However, the graft was clear and unattached to the retrocorneal membrane. The membrane then diagnosed to be the remaining descemet's membrane from the recipient. Pathology report of the excised cornea revealed  extensive changes consistent with  CDK, subtotal absence of bowman’s layer with absence of descemet's membrane and endothelial layer. In further follow ups the patient's visual acuity decreased from 20/200 to 20/400. Which is thought to be due to the retained descemet’s membrane opacification, therefore membranectomy with neodymium-dpoed yttrium alumnium garnet (Nd:YAG) laser was done, Vision was improved to 20/100.

In conclusion, retained descemet’s membrane is a rare complication of PKP and only few are reported in the literature especially for patients with CKD.

This case also features the importance of considering a retained DM as one of the differentials when a patient presents with decreased visual acuity post- PK. Physicians need to be attentive when examining the anterior segment post-operatively.

Different approaches that help decrease the risk of complications need to be implemented at the time of surgery.