Spontaneous Descemet Membrane Detachment

To report a case of spontaneous Descemet membrane (DM) detachment occurring several years after penetrating keratoplasty (PK) for keratoconus.

Review of the patient took place in the eye clinic in St.James's Leeds teaching hospital. She attended multiple visit in which she has undergone thorough eye examination. Investigations required for the patient were done in the same setting. For the procedure required, she had it done in the theater room in the same hospital but different buliding. 

A retrospective review of a patient who developed spontaneous DM detachment many years post- PK.

A 50 year old female patient presented to the clinic with a sudden onset of blurred vision in her left eye. She had undergone PK for keratoconus twice in that eye , last one in 2018.Slit lamp examination revealed a localized area of corneal oedema with epithelial bullae. AS-OCT (MS39) confirmed DM detachment.

The patient underwent pneumatic descemetopexy the following day in the operating theatre. Sulfur hexafluoride 15% (SF6) bubble was injected into the anterior chamber, with tamponade at high pressure for 10 minutes followed by decompression and an additional 10- minute tamponade.

At the one-week follow-up, the cornea was clear, and her BCVA improved to 6/60.

AS-OCT was repeated and confirmed complete attachment of the DM. 

To conclude, Spontaneous Descemet membrane (DM) detachment is a rare complication that can occur after uncomplicated penetrating keratoplasty (PK). Since corneal edema in post-PK patients is often attributed to graft rejection or failure, the diagnosis of DM detachment may be delayed.

We recommend early review by a cornea specialist and performing anterior segment optical coherence tomography (AS-OCT) in any post-PK patient presenting with new-onset corneal edema to ensure timely diagnosis and appropriate management.

Ongoing research continues to improve our understanding of this condition and aims to optimize patient outcomes.