Purpose: To describe corneal clearance after reendothelialization of the recipient posterior stroma, by a "free-floating" donor Descemet roll in the recipient anterior chamber after Descemet membrane endothelial keratoplasty (DMEK), as a potential new approach in managing corneal endothelial disorders.
Methods: An 80-year-old woman underwent DMEK for Fuchs endothelial dystrophy. Within hours after the surgery, a "free-floating" Descemet roll was observed in the recipient anterior chamber. Because the operated eye had low visual potential, the patient requested to await the clinical outcome, which was monitored by biomicroscopy, and endothelial cell density (ECD) and pachymetric measurements were evaluated.
Results: Within the first few weeks after DMEK, the transplanted cornea showed diffuse corneal edema with a central pachymetry of more than 1000 μm. From 1 month onward, the transplanted cornea started to clear in the inferior quadrants. At 6 months, only remnant edema was present in the superior far periphery, pachymetry across the cornea had returned to normal, and ECD measured 830 cells per square millimeter.
Conclusions: The performance of a descemetorhexis followed by the implantation of a "free-floating" Descemet roll in the recipient anterior chamber, tentatively named Descemet membrane endothelial transfer, may have potential as a "no-keratoplasty" surgical concept in the management of corneal endothelial disorders.