PMC8264843_01
(a) Anterior segment ocular coherence tomography (OCT) at 1, 2 and 4 weeks
after initial phacoemulsification with intraocular lens implantation and
Descemets Membrane Endothelial Keratoplasty (DMEK). (b) 1 week post DMEK
suturing. (c) Anterior segment OCT scans at various levels to show the DMEK
attachment and posterior protuberance.
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One week post-operatively the cornea appeared oedematous with inferior detachment of DMEK graft (Figure 1(a)). One week later, he was noticed to have persistent inferior graft detachment and corresponding corneal oedema (Figure 1(a)); therefore, the second re-bubbling was performed at the slit lamp in the same fashion. His cornea remained oedematous inferiorly at 4 weeks due to persistent inferior Descemet membrane detachment (Figure 1(a)) despite two subsequent re-bubblings. Careful inspection of his anterior segment OCT (AS-OCT) revealed a ridge on the posterior surface of the graft-host junction infero-nasally (Figure 1(a)), which was the probable cause of his recurrent inferior Descemet membrane detachment. Care was taken not to tear the detached Descemet with unnecessary needle movement in the anterior chamber (Supplemental Video 1) (Figure 1(b)). One week post-operatively, his AS-OCT confirmed complete attachment of the DMEK graft with clear appearance of posterior protuberance (Figure 1(c)).
(a) Anterior segment photograph 8 months post-operatively. (b) Anterior
segment OCT scans 8 months post-operatively.
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His corneal oedema resolved (Figure 2(a) and (b)) and his visual acuity gradually improved.