title: Corneal graft failure following Nd:YAG laser membranotomy for inadvertent retained descemet's membrane after penetrating keratoplasty.
abstract: Retained Descemet's membrane (DM) following penetrating keratoplasty (PKP) is a rare finding that may reduce visual acuity following opacification or endanger the graft endothelium. The association between Nd:YAG laser membranotomy and corneal graft failure is reported. Five of 1,350 patients (0.37%) undergoing PKP for pseudophakic bullous keratopathy or graft failure between 1986 and 2008 presented with inadvertent retained DM located close to the graft endothelium. The membrane opacified within 3 to 4 months, reducing the patients' vision. Nd:YAG laser membranotomy was performed using low energy and few pulses. Patients' visual acuity improved from 6/40 to 6/90 before treatment to 6/15(-) to 6/20 at 2 weeks following membranotomy. However, the corneal graft decompensated within 6 to 8 weeks following this procedure, necessitating repeat PKP, with removal of the retained DM. Nd:YAG laser membranotomy may lead to corneal graft failure due to shockwave damage created by the laser pulses, focused near the endothelial surface.
authors.affiliation: Department of Ophthalmology, Rabin Medical Center, Beilinson Campus, Petach Tikva, Israel.
authors.forename: Israel
authors.initials: I
authors.lastname: Kremer
authors.forename: Ayelet
authors.initials: A
authors.lastname: Dreznik
authors.forename: Gili
authors.initials: G
authors.lastname: Tessler
authors.forename: Irit
authors.initials: I
authors.lastname: Bahar
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D016039:Corneal Transplantation; D003886:Descemet Membrane / Q000601:surgery*; D006084:Graft Rejection / Q000209:etiology*; D006801:Humans; D015948:Keratoplasty, Penetrating / Q000009:adverse effects*; D053685:Laser Therapy; D011183:Postoperative Complications / Q000601:surgery*; D012189:Retrospective Studies; D014792:Visual Acuity