PMC3460700_01
Consecutive images of a repeat manual deep anterior lamellar keratoplasty (DALK). During the procedure, there was continuous localized sweating of aqueous through Descemet's membrane, but no microperforation was observed. (A) Central descemetocele due to cornea melting in uncomplicated DALK 7 months after surgery for a suspected neurotrophic central ulcer with descemetocele. (B) Sweating of aqueous through Descemet's membrane and subsequent accumulation of fluid (arrow) over the recipient bed. The fluid prevents clear visualization of the surgical plane. (C) Recipient bed immediately after drying of the sweating. Now it is possible to see the surgical plane clearly and no microperforation is identified. (D and E) Consecutive images taken 15 seconds apart showing localized and continuous sweating through Descemet's membrane (arrows). (F and G) Consecutive images after complete manual dissection. The former is immediately after drying of the recipient bed and the latter is after 2 minutes of continuous sweating of aqueous from Descemet's membrane. The arrows indicate the specific location of Descemet's membrane that sweats; perhaps an area with a nonvisible micron perforation. (H) Final image after successful redo DALK.
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She developed cornea melting with a central descemetocele (1.2 x 0.8 mm) over the DALK graft which was located in the same area as the previous descemetocele (Figure 1A). Constant drying of the cornea was necessary to proceed with the surgery (Figure 1B and C). Following complete removal of the lamellar graft, a localized area of Descemet's membrane sweating of aqueous was identified in an area of intact Descemet's membrane (Figure 1D-G). A new graft was sutured as in standard DALK (Figure 1H).