Iatrogenic Descemet membrane detachment in the donor lenticule during Descemet stripping automated endothelial keratoplasty.

A female patient in her 60s presented with an 8-month history of decreased vision in her right eye. She was diagnosed with pseudophakic bullous keratopathy (PBK), and Descemet stripping automated endothelial keratoplasty (DSAEK) surgery was planned. Intraoperative Descemet membrane detachment (DMD) occurred while inserting the lenticule using the Sheets glide technique. The detachment of the Descemet membrane was detected immediately, and air descemetopexy was performed intraoperatively. Postoperatively, the donor lenticule was attached properly to the stromal bed, except for a focal DMD approximately 3 mm in the inferior part of the lenticule. A second descemetopexy was performed 5 days later, resulting in a complete attachment. A DMD in DSAEK lenticule is an extremely rare complication. Early detection and timely intervention with descemetopexy helped achieve a good anatomical and functional outcome.