不同方法获取Descemet膜-角膜内皮细胞复合体的效果比较

目的评价不同方法获取Descemet膜-角膜内皮细胞复合体(DM+CECs)的效果。方法将20只兔(40只眼)根据手术方法的不同随机分成4组:镊子剥离组、水分离组、大气泡法组和机械分离组,每组10只眼。通过活体染色和组织切片分析评价DM+CECs。结果成功获取DM+CECs镊子剥离组2眼,水分离组8眼,大气泡法组5眼,机械分离法组3眼,4个组之间的成功率差异有统计学意义(P<0.05)。水分离法组(98.03±2.18)%和大气泡法组(97.14±3.04)%内皮细胞存活率(ESR)明显高于镊子剥离法组(80.16±5.21)%和机械分离法组(71.56±9.57)%(F=436.04,P<0.05)。苏木精-伊红染色显示水分离法和大气泡法对内皮细胞损伤小。结论水分离法或大气泡法是安全、有效地获取DM+CECs的技术。

Descemet＇s membrane detachments post cataract surgery：a management paradigm

Descemet’s membrane detachments （DMD） are relatively common after cataract surgery and most do not require any treatment. However, if large DMD are not treated appropriately, significant visual morbidity can ensue. We aim to develop a guideline for the management of DMD post cataract surgery based on a retrospective review of all cases encountered at the Royal Victorian Eye and Ear Hospital, Melbourne, Australia over a 4-year period from 2010 to 2014. We suggest conservative management if the visual axis is not involved; however, after 3mo surgical intervention may be warranted to prevent corneal sequelae. In cases where the visual axis is involved we suggest early intervention with air tamponade. The main risk factor for irreversible corneal oedema and subsequent endothelial transplant appears to be direct endothelial trauma rather than the DMD itself.

Clinical results of non-Descemet stripping endothelial keratoplasty

AIM： To investigate the impact of non-Descemet stripping endothelial keratoplasty（non-DSEK） on graft rejection rate,and its overall procedural effectiveness in patients.METHODS： Non-DSEK was performed on 65 eyes of 64 patients,and the procedural outcomes,including rejection episodes,failure and dislocation of the grafts,best corrected visual acuity（BCVA）,endothelial cell density（ECD）,and other complications,were analyzed retrospectively.RESULTS： Of the 65 eyes,63 recovered from bullous keratopathy with a clear cornea.The mean follow-up time was 26.4mo（range,6-84mo）.The mean BCVA improved from 1.70 log MAR preoperatively to 0.54 log MAR at 3mo,0.46 logM AR at 6mo,and 0.37 logM AR at 1y after surgery.The postoperative donor ECD of the 25 patients who successfully underwent specular microscopic examination was 1918±534 cells/mm^2（range,637 to 3056 cells/mm^2）,and the mean endothelial cell loss was 41.9% at 24 mo postoperatively.One eye developed secondary glaucoma and required regrafting via penetrating keratoplasty（PKP）.Another eye had postoperative graft failure due to rejection at 26 mo.Postoperative graft dislocation occurred in eight eyes.All of the eight dislocated grafts were reattached using air reinjection.CONCLUSION： Immunological graft rejection of the donor graft rarely occurs in non-DSEK.Therefore,non-DSEK is a safe,concise,and effective alternative to restore corneal decompensation when the Descemet membrane is disease-free.

Descemet membrane detachment after trabeculectomy

Descemet's membrane detachment (DMD) can be a potentially serious complication of intraocular surgery or ocular trauma. The cause is not very clear. We are trying to remind an awareness of the spectrum of DMD resulting from trabeculectomy by presenting a case of extensive DMD after trabeculectomy which was successfully repaired.

Combined Descemet stripping automated endothelial keratoplasty and intravitreal dexamethasone implant for concomitant pseudophakic bullous keratopathy and cystoid macular edema

Dear Editor,Endothelial cell density decreases with age and in various ocular conditions,including corneal endotheliitis,uveitis,pseudoexfoliation syndrome,and birth injury(1)The reduction of endothelial cell density is exacerbated over time after intraocular surgery(1)Descemet stripping automated endothelial keratoplasty(DSAEK)is considered the primary procedure for patients with only endothelial dysfunction.

Visual acuity and endothelial cell density with respect to the graft thickness in Descemet's stripping automated endothelial keratoplasty: one year results

AIM: To evaluate the visual acuity and endothelial cell density according to the thickness in Descemet’s stripping automated endothelial keratoplasty(DSAEK)one year after surgery.METHODS: DSAEK patients’ data were reviewed. Thirty seven eyes of 37 patients who underwent DSAEK for pseudophakic bullous keratopathy(PBK) were included in this study. Graft thickness was measured with optical coherence tomography(OCT) 12 mo after DSAEK. Eyes were divided into 3 groups based on the graft thickness:thick(】200 μm), medium-thick(150-200 μm) and thin(【150 μm). Best corrected visual acuity(BCVA),endothelial cells density(ECD) and complications were assessed and comparisons were done between groups.RESULTS: Median thickness of postoperative grafts was 188(range 73-317 μm). There was no significant difference in age, sex, preoperative BCVA, or follow-up period between DSAEK groups. At postoperative 12 mo,mean BCVA was 0.28±0.10 in thick graft group, 0.52±0.08 in medium-thick graft group, and 0.72 ±0.06 in thin graft group. Thin grafts showed better postoperative BCVA as compared with the medium-thick and thick grafts(P =0.001). Thick graft group had 1637.44 ±88.19-mm2,medium thick graft had 1764.50±34.28-mm2 and thin graft group had 1845.30 ±65.62-mm2. Thin graft group had better ECD at 12 mo after surgery(P =0.001).CONCLUSION: Thin grafts after DSAEK ensure better visual rehabilitation. Eyes with thin grafts had significantly lesser loss of ECD compared to eyes withmedium-thick and thick grafts one year after surgery.

Descemet stripping automated endothelial keratoplasty in phakic eyes:incision modification reducing cataract formation

AIM： To evaluate the efficacy of a technical modification to reduce the incidence of traumatic cataract induced by Descemet stripping automated endothelial keratoplasty（DSAEK） performed in phakic eyes. METHODS： A retrospective cohort study. The records of all patients with a clear crystalline lens and endothelial failure that underwent modified DSAEK at our insitution were reviewed. In this modification, in order to avoid inadvertent touch of the insertion forceps against the exposed crystalline lens while passing across the anterior chamber, the incision sites were shifted from the standard 9 and 3 o＇clock positions, superiorly to the 10 and 2 o＇clock position respectively. Formation of typically traumatic, anterior subcapsular cataract in these patients was compared to that observed in a cohort including all the patients with a clear crystalline lens and endothelial failure that underwent conventional DSAEK at our institution.RESULTS： The study group included 49 eyes following modified DSAEK and the control group included 35 eyes following DSAEK with conventional incision sites. Anterior subcapsular cataract occurring 4 mo or less postoperatively was identified in 2 of 49（4%） eyes in the study group and 7 of 35（20%） eyes in the control group. The rates of traumatic cataract were significantly higher in the control group in comparison to the study group（P=0.03, RR=4.9, 95%CI 1.08-22.1）.CONCLUSION： Traumatic cataract formation following phakic DSAEK may be avoided with a simple modification to the position of the incision sites.

Complications and outcomes of descemet stripping automated endothelial keratoplasty with artisan aphakia intraocular lens implantation

AIM： To evaluate the complications and outcomes of descemet stripping automated endothelial keratoplasty（DSAEK） combined with artisan aphakia intraocular lens（IOL） implantation in severely damaged eyes without capsular support.METHODS： DSAEK combined with artisan iris claw IOL implantation was performed on 29 eyes. All eyes were of abnormal structure due to complications from prior intraocular surgeries and ocular trauma. Ocular complications observed included graft dislocations, high intraocular pressure（IOP）, IOL dislocations, macular edema and hyphema. Best corrected visual acuity（BCVA）, IOP and mean central endothelial cell density（ECD） were recorded.RESULTS： Thirteen eyes had a history of ocular trauma, 10 eyes had an anterior chamber IOL, 16 eyes had prior vitrectomy. The iris was abnormal in 22 cases. Graft dislocation occurred in 5（17.2%） of 29 eyes. IOL dislocation occurred in 2 eyes（6.9%）. High IOP was found in 9 eyes and was controlled with treatment. The preoperative mean BCVA was 20/286. The 6 mo postoperative mean BCVA was 20/42. The average center ECD was 1965.3 cells/mm^2 at 6 mo, and the rate of the donor cell loss was 34.7%.CONCLUSION： DSAEK combined with artisan aphakia IOL implantation is an alternative option for resolving endothelial and lens disorders in aphakic eyes without capsular support. However, it should be performed cautiously for eyes with severe iris defects.

Descemet-membrane endothelial keratoplasty in patients with retinal comorbidity -a prospective cohort study

AIM： To investigate indications, surgical challenges, and outcome of Descemet -membrane endothelial keratoplasty （DMEK） in patients with retinal comorbidities （RC）. METHODS： In a prospective cohort study, 8 eyes of 8 DMEK-patients with known RC were compared to 38 eyes of 38 DMEK-patients without RC. The duration of surgery, the degree of difficulty graded by the surgeon, and the complications through DMEK-surgery were analyzed for each patient. The best-corrected visual acuity （BCVA）, the endothelial cell count, the intraocular pressure, and the subjective satisfaction was evaluated after a 6-month follow-up. Data were compared applying the non-parametric Wilcoxon-, Chi-square- and Fisher＇s-exact-test with P≤ 0. 05 as level of significance. RESULTS： RC-patients had dry age-related macular degeneration （n=4） or history of pars-plana vitrectomy （n=4）. The main indication for DMEK was pain due to bullous keratopathy for the RC-patlents （n=7, 88%） and visual impairment due to Fuchs endothelial keratoplasty for the non-RC-patients （n=33, 87% ）. The BCVA increased for both groups （P=0.01, P〈0.001） and all corneas cleared. For the RC-patients, the subjective satisfaction improved significantly （P=0.02）. Oil-filling and missing support of the vitreous body complicated surgery in vitrectomized eyes. CONCLUSION： DMEK is a favorable technique to treat endothelial disorders even if patients suffer from a retinal comorbidity. By enhancing the corneal clarity, it enables retinal examination or intraocular surgery and increases the patients satisfaction. However, in vitrectomized or silicone-oil filled eyes, the duration of surgery and degree of complexity are increased. An experienced surgeon should perform DMEK in these patients. Clinical trial registration number： DRKS00007566.

Incidence of cystoid macular edema after Descemet's stripping automated endothelial keratoplasty

AIM： To determine the incidence of cystoid macular edema（CME） after Descemet＇s stripping automated endothelial keratoplasty（DSAEK）.METHODS： This study included all consecutive patients operated in a Spanish tertiary reference hospital over a period of four years. A total of 55 eyes from 47 patients matched the selection criteria. CME was diagnosed clinically at the slit-lamp and confirmed by optical coherence tomography. RESULTS： Six cases of CME were diagnosed postoperatively, which represented an incidence of 11%. Three patients had previously undergone DSAEK alone（7%; 3/41） and the other three, DSAEK combined with phacoemulsification（21%; 3/14）. Five out of six patients with CME responded to standard therapy.CONCLUSION： CME is a possible complication after DSAEK and can be treated with standard therapy. CME appears more frequently when DSAEK is combined with phacoemulsification and posterior chamber（PC） intraocular lens（IOL） implantation. Intraoperative damage to the corneal endothelial cells might play a role in the pathogenesis of CME. As long as the causes remain unclear, we recommend administering prophylaxis when risk factors are present or when combined surgery is planned.

Modified thin manual Descemet stripping endothelial keratoplasty with air-guided, non-pachymetric donor lenticule dissection: outcomes of graft thickness and complication rate

●AIM:To describe a modified technique of donor lenticule dissection for thin manual Descemet stripping endothelial keratoplasty(TM-DSEK).●METHODS:Donor material was soaked in balanced salt solution(BSS)for 30 min,before being mounted on an artificial anterior chamber(AAC).Rather than BSS,the AAC was filled with filtered air,resulting in a visible reflection at the corneal endothelium-air interface.This reflection served as a landmark for the depth of the dissection,facilitating the creation of a thin lenticule with low risk of perforation.Dissection was commenced at a standardized depth of 500 microns,with no initial pachymetry necessary.Totally 29 donor corneas were dissected by a novice TM-DSEK surgeon.Dissection time,central graft thickness at 2 mo and complications were analysed.●RESULTS:Results were similar to other endothelial keratoplasty techniques,despite the cases being performed by a novice DSEK surgeon.Mean dissection time was 7 min(range 6-10).One graft perforation occurred(3.45%),but the air tamponaded the break and enabled dissection to be restarted and completed from a different location.Mean central graft thickness after at least two months follow-up was 106 microns(range 25-170).●CONCLUSION:A problem with manual DSEK is the risk of graft perforation by attempting to dissect too thin a lenticule,or creating a thick graft due to fear of perforating.This modified air-guided technique addresses this problem,and is recommended for surgeons either embarking on the learning curve,or who wish to achieve more consistently thin grafts while reducing perforation rates.

A Novel Y-Suture Transfixation Technique to Improve Graft Adherence in High-Risk Descemets Stripping Automated Endothelial Keratoplasty

Purpose: To report a novel Y-suture transfixation technique to improve success rate of high-risk Descemets stripping automated endothelial keratoplasties (DSAEK). Design: Retrospective non-comparative case series. Participants: Twenty five high-risk patients undergoing DSAEK at one tertiary care institution. Methods: A retrospective evaluation of consecutively enrolled high-risk DSAEK cases performed by three surgeons at one institution during a 3-year period (2007-2010). Main outcome measures were graft adherence and suture-related complications. Results: Highrisk factors were defined as followed: prior incisional glaucoma surgery (58%), presence of vitreous in the anterior chamber (15%), anterior chamber intraocular lens (8%), graft dislocation (8%), previous DSAEK (8%), and iris trauma/aphakia (3%). Twenty-five high-risk patients underwent DSAEK with Y-suture transfixation. Postoperative follow-up ranged from 3 to 27 months. One patient had dislocation due to hypotony from prior trabeculectomy (4%), requiring repeat DSAEK. Neither primary graft failure nor suture-related complication was observed. Conclusion: The Y-suture transfixation technique is associated with improved success rate of high-risk DSAEK transplant.

Suturing Technique to Promote Graft Attachment in Challenging Cases of Descemet Stripping Endothelial Keratoplasty

Aims: To describe a technique that uses a transcorneal fixation suture for graft attachment in endothelial keratoplasty in high-risk for graft dislocation eyes. Materials and Methods: Case series included 12 eyes of 12 patients who underwent Descemet Stripping Automated Endothelial Keratoplasty (DSAEK) in the presence of high risk for graft dislocation factors. We describe a surgical technique that uses a transcorneal fixation suture to compress the donor graft onto the back surface of the recipient cornea. Outcome measures included intraoperative and postoperative complications, graft attachment and clarity and endothelial cell count at a 12 months follow-up period. Results: No intraoperative complications were noted and 11 grafts remained attached and clear with no suture related complications at a 12-month follow-up period. Partial peripheral graft detachment due to suture related graft folds, accompanied by mild corneal edema was noticed in one patient postoperatively. Reattachment and edema resolution occurred spontaneously after suture removal. The mean endothelial cell loss was 38.21% at 12 months. Conclusions: Temporary transcorneal fixation suture can be helpful in preventing graft detachment in eyes with high risk for graft dislocation.

Simultaneous tectonic Descemet stripping endothelial keratoplasty and tectonic Bowman layer transplant for the management of corneal perforation

AIM:To report the outcomes of three cases of corneal perforation managed with simultaneous tectonic Descemet stripping endothelial keratoplasty(t-DSEK)and tectonic Bowman layer transplant(t-BLT)as an alternative to tectonic penetrating keratoplasty(t-PKP).METHODS:Three eyes of three patients receiving simultaneous t-DSEK and t-BLT for corneal perforation were included.The technique for DSEK was modified depending on individual requirements.The t-BLT technique was standardised using an 8 mm graft and fixated with a running suture.Success was measured by the ability of this procedure to close a corneal perforation.RESULTS:All three cases achieved tectonic eye globe restoration and remained stable during the minimum 3-month observation period.Reinterventions were relatively common:2 cases required amniotic membrane transplant for persistent epithelial defects.One case required DSEK rebubbling.One case developed angle closure glaucoma requiring surgical peripheral iridectomy.CONCLUSION:Simultaneous t-DSEK and t-BLT may be a useful strategy for the management of corneal perforation as an alternative management to t-PKP for selected cases.

Ultrathin Descemet stripping automated endothelial keratoplasty versus Descemet membrane endothelial keratoplasty:a fellow-eye comparison

Background:To compare the visual outcome and patients’satisfaction after ultrathin Descemet stripping automated endothelial keratoplasty(UT-DSAEK)and Descemet membrane endothelial keratoplasty(DMEK)performed on fellow eyes of the same patients.Methods:In this retrospective study,the records of 18 pseudophakic patients affected by Fuchs endothelial dystrophy who underwent DMEK in one eye and UT-DSAEK in the fellow eye were reviewed.Best corrected visual acuity(BCVA),corneal pachymetry,keratometry,corneal aberrations,photopic and mesopic contrast sensitivity,and endothelial cell counts measured 12 months after surgery in either eye were analyzed and compared.The results of a satisfaction questionnaire were also reviewed.Results:Twelve months after surgery,BCVA was not significantly different in UT-DSAEK and DMEK eyes(0.10±0.04 and 0.07±0.07 logMAR,respectively);at both 4-and 6 mm optical zones total and posterior corneal higher order aberrations(HOAs),posterior astigmatism and total coma were significantly lower after DMEK;BCVA in both groups was significantly correlated mainly with anterior corneal aberrations;contrast sensitivity was higher after DMEK especially in mesopic conditions and at medium spatial frequencies;the endothelial cell density was similar,although slightly higher in the UT-DSAEK group(p=0.10).The satisfaction questionnaire showed that although patients were highly satisfied from both procedures,more than half of them preferred DMEK and reported a more comfortable and quicker postoperative recovery.Conclusions:DMEK and UT-DSAEK showed no evidence of difference in terms of postoperative BCVA,although DMEK had a better performance in terms of contrast sensitivity,posterior corneal aberrations and overall patient satisfaction.

Corneal Endothelial Cell Loss in Femtosecond Laser-assisted Descemet＇s Stripping Automated Endothelial Keratoplasty： A 12-month Follow-up Study

Background：Descemet＇s stripping automated endothelial keratoplasty （DSAEK） surgery offers a more standardized approach and reliable method to create corneal grafts with an instrument such as a microkeratome.With the development of Descemet＇s membrane endothelial keratoplasty,an excellent clinical outcome is seen in the treatment of corneal endothelial dysfunctions,which indicates that thinner corneal graft results in better clinical outcome.With the recent development of the femtosecond laser,ultrathin corneal graft preparation has become possible.This study aimed to report corneal graft endothelial cell loss （ECL） in a large series of cases undergoing DSAEK with femtosecond laser-assisted corneal graft preparation within a 12-month period.Methods：This study was designed as a prospective,noncomparative,interventional case series.Totally 126 consecutive eyes with endothelial failure of 120 patients,who had corneal endothelial decompensation and underwent femtosecond-assisted DSAEK using the VisuMax femtosecond laser system,were included in the study.Central endothelial cell density （ECD） was recorded postoperatively at 2 weeks （n =126）,1 month （n =126）,3 months （n =110）,6 months （n =101）,and 12 months （n =71） and then compared with the preoperative eye bank measurements.Pre-and postoperative central ECDs were evaluated using Heidelberg retina tomography-Ⅲ confocal microscopy.ECL was calculated for each postoperative time point.Graft thickness was examined using anterior segment-optical coherence tomography.Results：Mean preoperative cell count was 3383 ± 350 cells/mm^2.Mean postoperative cell counts were 2382 ± 707 cells/mm^2,2179 ± 685 cells/mm^2,2074 ± 688 cells/mm^2,1884 ± 662 cells/mm^2,and 1723 ± 624 cells/mm^2 at 2 weeks,1,3,6,and 12 months,respectively;these represented the ECL of 29.7 ± 19.7%,35.4 ± 19.5%,38.6 ± 19.8%,44.3 ± 18.9%,and 48.9 ± 18.4% at the each corresponding time point.The mean corneal graft thickness after surgery was 142 ± 48 μm,118 ± 41 μm,108 ± 37 μm,100 ± 32 μm,and 99 ± 32 μm at each corresponding study visit,respectively.There was no correlation between corneal graft thickness and corneal ECL （R =0.039）.Conclusions：Corneal ECL remained relatively stable up to 12 months after femtosecond laser-assisted ultrathin DSAEK in a large case series.No correlation between cell loss and corneal graft thickness was found,which indicated that corneal graft preparation by the femtosecond laser was safe.ECL was faster within the first 6 months and relatively stable thereafter.

移植物厚度对角膜内皮失代偿行简易后弹力层角膜内皮移植效果的影响

背景:研究表明较薄移植物视力恢复更快、排斥风险更低,国内缺乏对内皮移植术后不同植片厚度的临床疗效分析,因此,确定最佳移植物厚度对于提高手术疗效至关重要。目的:评价简易后弹力层剥离内皮角膜移植术后不同植片厚度对视力恢复及其他预后指标的影响。方法:选取2013年1月至2023年2月在北部战区总医院接受简易后弹力层剥离内皮角膜移植手术治疗的角膜内皮失代偿患者共72例(72眼),其中薄植片组(<100μm)32例(32眼),厚植片组(≥100μm)40例(40眼)。随访1年,观察两组术前及术后1,3,6,12个月的最佳矫正视力,术后1年角膜内皮细胞数、角膜植片透明度、术后并发症、植片生存情况。结果与结论:①两组患者术后视力较术前均有显著提高,薄植片组患者术后3个月最佳矫正视力优于厚植片组(P<0.05);②两组术后1年角膜内皮细胞数及植片透明度比较差异无显著性意义(P>0.05);③两组患者继发性青光眼、植片免疫排斥、植片移位等术后并发症发生率比较差异无显著性意义(P>0.05);④两组术后1年植片生存率比较差异无显著性意义(93.8%,92.3%,P>0.05);⑤结论:简易后弹力层剥离内皮角膜移植术是一种安全有效的角膜内皮移植手术方式,其术后疗效与传统后弹力层剥离内皮角膜移植术相似,而且植片植入方式更为简便。较薄植片能够更早提供最佳矫正视力,更早完成角膜重塑,因此在治疗角膜内皮失代偿疾病时,优先选择薄移植物来提高恢复时间。

Preparation, preservation, and morphological evaluation of the donor graft for descemet membrane endothelial keratoplasty： an experimental study

Background Though there have been various methods for harvesting and preserving descemet membrane （DM） and intact endothelium,there is no literature about the morphological evaluation of endothelium after graft preparation for descemet membrane endothelial keratoplasty （DMEK）.The aim of this study was to establish and improve a simple method for preparing,preserving,and morphologically evaluating the donor graft for DMEK.Methods To obtain a donor graft,an air bubble was formed by injecting a 29 G needle with 1 ml sterile air into a small edge created outside the Schwalbe line.Another needle was inserted into the bubble through the stroma to aspirate the air or replace half the air with organ culture medium.Trypan blue was used to mark the location for small incision to improve the success rate.Frozen sections were stained with hematoxylin and eosin （HE）.Based on the air bubble,DM grafts were divided into four groups：group A （normal control）,graft without any operative technique; group B,graft with zero-pressure air bubble; group C,graft with full-pressure air bubble; group D,graft with half-pressure air bubble.The four groups of grafts were preserved for 24 hours to observe the effect of bubbles on cells.The gross and ultrastructure morphologies were evaluated using alizarin red and scanning electron microscopy （SEM）,respectively.Results Donor grafts were harvested via the air bubble technique,facilitated by prior trypan blue staining.HE-stained sections revealed a pure graft without stroma.There were no significant changes under light microscope.In group A,SEM revealed a confluent layer of polygonal endothelium with distributed microvilli exhibiting characteristics of interdigitating junctions.In group B,intercellular borders became thinner.In group C,interdigitations were almost flat and microvilli were observed less frequently.In group D,other than less microvilli,there were minimal changes.Conclusions The donor graft preparation method appears to be effective and convenient.Properly decreasing the air pressure could protect and preserve the endothelium.

Surgical management of spontaneous,lateonset Descemet membrane detachment after penetrating keratoplasty for keratoconus:a case report

Background:To report a surgical method for treating corneal oedema in a case of late-onset Descemet membrane detachment after penetrating keratoplasty.Case presentation:A 55-year old patient presented with sudden visual loss in his left eye 28 years after penetrating keratoplasty for keratoconus.Slit-lamp biomicroscopy revealed a distortion of the corneal graft anatomy with protrusion of the graft and peripheral thinning and steepening in the residual host tissue,accompanied by corneal graft oedema.Anterior segment optical coherence tomography revealed detachment of Descemet membrane localized to the area of the graft oedema.We proceeded with a full-thickness,partially circumferential incision in the graft-host junction,followed by repositioning and re-suturing of the graft in place,and intracameral air injection in order to achieve reattachment of Descemet membrane.Conclusions:Corneal graft repositioning in combination with re-bubbling may represent an effective therapeutic option in keratoconic patients with peripheral thinning in the residual host corneal tissue and subsequent Descemet membrane detachment.