Abstract
We present a case of acute graft edema due to late-onset Descemet's membrane detachment (DMD) in a penetrating keratoplasty done two decades ago for keratoconus. A 48-year-old male presented with defective vision and redness in the right eye. The absence of the anterior chamber (AC) inflammation, keratitic precipitates, and the presence of glistening reflex in the AC, with a double contour along the inferotemporal graft host junction, suggested an acute hydrops in the graft. An anterior segment optical coherence tomography (ASOCT) confirmed DMD with the absence of an obvious tear. In the region of the double contour, a lamellar flap/fold of DM beyond the graft host junction (GHJ) but within the detachment and stroma was noted. Descemetopexy with intracameral sulfur hexafluoride gas and compression sutures along the region of the double contour restored graft clarity and vision. A DMD should be considered as a possible cause of acute edema and can be often misdiagnosed as graft rejection.
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