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Retention of Host Embryonic Descemet Membrane in Endothelial Keratoplasty

Objective: To describe a case of retained host embryonic Descemet membrane (DM) after Descemet stripping automated endothelial keratoplasty (DSAEK). Methods: Review of clinical findings in a case of DSAEK with retention of host embryonic DM. Results: A geographic and patchy haze in the interface involving the visual axis was noted postoperatively as soon as 1 week after DSAEK surgery. This was noted on clinical exam and thought to be retained embryonic DM. Review of pathology on the explanted DM confirmed delamination of DM with absence of the anterior embryonic layer and only patchy areas of full-thickness DM. The haze was followed over time and did not regress over the first 6 months after surgery. It did not seem to affect vision significantly, and the patient achieved best spectacle-corrected vision of 20/30 by 6 months. Conclusions: Endothelial keratoplasty is a relatively new technique for posterior corneal transplantation. Variations in operative technique continue to be described. Delamination of DM during stripping can occur; however, retention of host embryonic DM in DSAEK surgery seems to be compatible with good vision.