A Clear Cornea Despite Persistent Dmek Detachment: A Case Report And Review Of Pathophysiology

this case study shows an interesting aspect that can be seen after the DMEK-Surgery, that a complete healing is possible, even if the graft was almost completely detached from the corneal stroma.

Observational case report of a patient seen at a tertiary health care center

A 60-year-old male patient with Fuchs endothelial corneal dystrophy underwent Descemet membrane endothelial keratoplasty (DMEK). Postoperatively, no corneal clearing was observed. Anterior segment OCT demonstrated an inverted graft orientation, with adherence limited to a small area of the posterior stroma, while the remainder was detached.

Given the persistent corneal edema and the confirmed inverted graft, repeat DMEK was planned and the patient was placed back on the waiting list. Several months later, once a new donor graft became available, preoperative assessment unexpectedly revealed a clear cornea, despite an unchanged extent of graft dehiscence on imaging. Pachymetry values and endothelial cell density had improved as well.

A review of the relevant literature is provided, and potential mechanisms underlying corneal recovery in such cases are discussed.

This case suggests that corneal recovery may occur even in the presence of persistent graft malposition/detachment.