Management of double anterior chamber after deep anterior lamellar keratoplasty using descemetopexy with corneal patch: A case report.

PURPOSE: To describe a staged approach using sulfur hexafluoride (SF6) descemetopexy and a temporary corneal stromal patch for the management of a double anterior chamber secondary to Descemet membrane detachment after deep anterior lamellar keratoplasty (DALK).

OBSERVATIONS: A 45-year-old man with advanced keratoconus underwent DALK using the type 2 big-bubble technique. A small peripheral Descemet membrane (DM) rupture occurred intraoperatively without evident aqueous leakage, and surgery was completed. In the early postoperative period, slit-lamp examination and anterior segment optical coherence tomography (AS-OCT) revealed a double anterior chamber (DAC) with clinically significant interface fluid. The patient was initially managed with the intraocular air/gas tamponade present after DALK and close observation. Because the detachment persisted over the following days, treatment was subsequently performed using intracameral 20% SF6 combined with placement of a temporary corneal stromal patch over the inferior DM rupture site. Complete anatomical reattachment was achieved within 24 hours after the combined intervention, with no recurrence during 4 months of follow-up before cataract surgery. Visual acuity improved from light perception at the time of intervention to 20/400 at 1 week and 20/320 during follow-up. After subsequent cataract surgery and additional refractive/corneal management, best-corrected visual acuity improved to 20/30.

CONCLUSIONS AND

IMPORTANCE

SF6 descemetopexy combined with a temporary corneal stromal patch was associated with rapid anatomical resolution of persistent postoperative DAC after DALK in this case. Although the additive benefit of the stromal patch over gas descemetopexy alone cannot be established from a single case, this staged approach may represent a useful adjunctive option in selected patients with persistent interface fluid and an identifiable peripheral DM rupture.