Descemet Membrane Detachment Triggered by Contrast-Enhanced Computed Tomography in a Patient with a History of Penetrating Keratoplasty for Keratoconus Treatment

Abstract

Introduction

We report a case of late-onset Descemet membrane detachment triggered by contrast-enhanced computed tomography more than 30 years after penetrating keratoplasty for keratoconus and describe its successful treatment with air tamponade.

Case Presentation

A 53-year-old woman with a history of uneventful penetrating keratoplasty more than 30 years ago for keratoconus presented with acute vision loss caused by corneal edema 2 days after undergoing contrast-enhanced computed tomography. Anterior-segment optical coherence tomography (AS-OCT) revealed corneal stromal edema in the graft and Descemet’s fold and partial Descemet membrane detachment without a tear. The patient received 0.1% betamethasone eye drops once every hour, along with sub-Tenon’s triamcinolone acetonide injection. Anti-inflammatory treatment improved corneal edema; however, the detachment area widened. Air tamponade facilitated complete Descemet membrane reattachment and improved corneal thickness with complete restoration of visual acuity.

Conclusion

An immune response may have been involved in the progression of Descemet membrane detachment in this patient. Anti-inflammatory treatment may have facilitated Descemet membrane reattachment prior to air or gas tamponade. AS-OCT is an excellent imaging modality to detect Descemet membrane detachment in eyes with presumed late penetrating graft rejection or failure.