Supernumerary Descemet’S Membrane: A Clinical Case

The purpose of this work is to describe an atypical case of supernumerary Descemet’s Membrane as the result of re-transplantation, in a patient undergoing penetrating keratoplasty.

Department of Ophthalmology, Centro Hospitalar e Universitário de São João, Porto, Portugal

A 61-year-old female patient with no personal medical history was oriented to the Cornea Department due to a bullous keratopathy in her left eye. The right eye didn’t show any alterations.

The patient underwent a penetrating keratoplasty in September 2007, which was successful.

After several months of follow-up, the patient had graft rejection, so she was re-transplanted.

After the surgery, biomicroscopy presented a transparent graft and intraocular pressure and fundoscopy were normal.

The best visual acuity presented was 6/10 without correction in left eye in 2013. 

After some years, there was another graft rejection, so she was submitted to another penetrating keratoplasty in February 2023. The surgery underwent without intercurrences.

In postoperative followup, the left eye biomicroscopy presented a transparent graft. However also showed a wavy transparent membrane in anterior chamber behind the graft.

The patient underwent an Anterior Segment Optical Coherence Tomography scan (Anterion) which showed the presence of a hyperreflective line in the anterior chamber which formed a hyporeflective fluid pocket between this hyperreflective line and the graft.

This membrane corresponded to a supernumerary Descemet's membrane from one previous graft.

Penetrating Keratoplasty has indication in many corneal diseases and present good outcomes. However, like every medical procedure, is not aware of complications. Retained Descemet’s membrane is a rare condition and can appears after incomplete removal of the host cornea.

The diagnosis is clinic with slit lamp examination. Ultrasound biomicroscopy and optical coherence tomography of the anterior segment can be used to confirm the diagnosis.

The retained Descemet’s membrane can compromise the endothelium of the graft by contact injury or by limiting diffusion of aqueous humour nutrients so, in some cases, surgical treatment is recommended.