Spontaneous resolution of Descemet membrane detachment after deep anterior lamellar keratoplasty

Purpose: To describe a patient whose Descemet membrane detachment following deep lamellar keratoplasty failed to respond to 2 attempts at gas tamponade but later resolved spontaneously. Methods: A 77-year-old woman with bilateral anterior corneal stromal scarring underwent a right deep lamellar keratoplasty with the Melles technique. Postoperatively, she developed an inferior Descemet membrane detachment, presumably due to a peripheral inferior microperforation. Two attempts at gas tamponade with sulfur hexafluoride (SF6) and 12% perfluropropane (C3F8) were made. Results: Gas tamponade was unsuccessful. Five months after deep lamellar keratoplasty, the detachment resolved spontaneously. One year after deep lamellar keratoplasty, the donor cornea was clear, and best corrected visual acuity in the right eye was 20/40 with -2.75/+2.50 x 55. Conclusions: Descemet membrane detachment after deep anterior lamellar keratoplasty can resolve spontaneously, even after failed attempts at gas tamponade. Those due to peripheral inferior perforations may be less likely to respond to tamponade than central or superior perforations.