Abstract
*Correspondence - Nadeem Ahmad: nadeem.ahmad123@doctors.org.uk
Objective To present an uncommon case of Descemet’s (DM) detachment 20 years following PK for keratoconus. The detachment spontaneously resolved with conservative management.
To review the literature and published case reports for the clinical course, prognosis, and managements employed for DM detachment following PK.
Methods and Analysis Case presentation of a patient presenting to our department and review of the literature.
Results Our patient presented with a spontaneous DM detachment 20 years after an uncomplicated PK for keratoconus. Imaging showed recurrence of corneal ectasia inferiorly, which would give this patient a poorer prognosis and higher risk of re-detachment after surgical intervention for the detachment. We opted for conservative management, after which the DM detachment spontaneously resolved and corneal thickness improved.
DM detachment is an uncommon late complication of PK and pathophysiology is thought to be mechanical due to a retrocorneal membrane, or due to recurrence of corneal ectasia. The majority of published cases underwent surgery with air, SF6, or C3F8 with postoperative supine positioning, or progression to repeat PK or DSAEK if this initial treatment fails. Topical steroids can be given for conservative management.
Conclusion Conservative management of DM detachment can be an option for patients with guarded prognosis, or in small detachments with no tears. Our case provides another data point on the presentation and progression of this complication to the small number of case reports in the literature.
