MANAGEMENT OF RESIDUAL DESCEMET MEMBRANE AFTER PENETRATING KERATOPLASTY: A CASE REPORT

To describe the diagnosis and surgical management of a residual Descemet membrane following penetrating keratoplasty (PKP) performed for corneal decompensation in an eye with previous glaucoma filtration surgery.

Ophthalmology Department, Hospital de Santa Maria, Lisbon, Portugal.

A 76-year-old female with advanced open-angle glaucoma, previously treated with Xen gel stent implantation and bilateral trabeculectomy, developed corneal decompensation in the left eye due to endothelial touch from the Xen implant. A partial amputation of the Xen stent and a PKP (trephines 7.75/8.00 mm, single interrupted sutures) was performed. Postoperatively, anterior chamber inflammation was observed, and anterior segment optical coherence tomography (AS-OCT) revealed a residual Descemet membrane from the recipient, resulting in localized interface irregularity and moderate graft edema. Surgical revision with excision of the residual membrane was performed without intraoperative complications. The graft remained attached and clear in the visual axis, the corneal edema improved, and best-corrected visual acuity went from counting fingers at 20 cm to 2 m. A small peripheral remnant of host Descemet membrane persisted nasally and temporally without affecting the visual axis. Intraocular pressure remained stable under topical medication. Follow-up AS-OCT confirmed persistance of the peripheral areas of Descemet remants and the resolution of interface edema.

Residual Descemet membrane after PKP can lead to persistent interface edema and limited visual recovery. Early recognition using AS-OCT and prompt surgical removal of the membrane can restore graft clarity and improve visual outcomes. However, such procedures may be technically challenging due to the thinness and fragility of the Descemet membrane and may not always be resolved in a single surgical intervention. AS-OCT plays a key role in the postoperative evaluation and monitoring of these patients.