Re‑Endothelialization of Bare Stroma after Descemet’s Detachment due to Macroperforation during Deep Anterior Lamellar Keratoplasty

Purpose: To report a case with spontaneous re‑endothelialization of bare stroma after subtotal detachment of Descemet’s membrane (DM) due to macroperforation during deep anterior lamellar keratoplasty (DALK). Methods: Case report. Results: A 64‑year‑old patient underwent DALK for deep stromal scarring secondary to herpetic keratitis. During manual dissection, DM macroperforation occurred, and this was successfully managed intraoperatively and postoperatively. The DM with host posterior stroma remained attached for 10 months when it detached from the bare donor stroma. The cornea remained clear, with uncorrected distance visual acuity (UCVA) of 0.17 logMAR. After graft suture removal 30 months later, he was noted to have regular astigmatism and cataract for which he underwent phacoemulsification with toric intraocular lens implantation. Twenty‑four months following his cataract surgery and 58 months following his DALK, his UCVA remains 0.17 logMAR and the cornea remains clear with no evidence of edema. His average specular count at 58 months was 1296 cell/mm2. Conclusion: This case shows a very good visual outcome with clear cornea at 58 months despite of large DM detachment which happened 10 months following manual DALK with intraoperative macroperforation.