title: Retained host Descemet membrane (Auto-DMET) during conversion of deep anterior lamellar keratoplasty to penetrating keratoplasty: a case report.
abstract: OBJECTIVE
  The aim of this study was to relate a case of deep anterior lamellar keratoplasty (DALK) converted to penetrating keratoplasty in which the host central Descemet membrane (DM) with a large perforation was left attached to the host cornea.
  
  
  METHODS
  This is a case report of a 34-year-old man who underwent an attempted DALK for keratoconus in his left eye, which became complicated with a large rupture in DM during dissection. The host DM was left in place, the donor cornea with DM intact was sutured onto the host bed, and air was injected into the anterior chamber. The patient was monitored by biomicroscopy, pachymetry, topography, anterior segment optical coherence tomography, and specular microscopy.
  
  
  RESULTS
  The postoperative course resulted in improved uncorrected visual acuity, best spectacle-corrected visual acuity, and topography. Corneal edema was observed in the host cornea peripheral to the graft. Three months after the surgery, the endothelial cell density was reduced by 63% compared with the preoperative donor cell density.
  
  
  CONCLUSIONS
  Leaving the host DM during conversion of DALK to penetrating keratoplasty was uneventful in this case, although corneal edema was observed in the area overlying the host cornea. It is possible that the retained DM could provide additional autologous endothelial cells to prolong graft survival.
authors.affiliation: *Department of Ophthalmology, Cornea and Anterior Segment Service, Wilmer Eye Institute, Johns Hopkins School of Medicine, Baltimore, MD; †Department of Ophthalmology, Federal University of São Paulo/Paulista School of Medicine, São Paulo, Brazil; and ‡Department of Ophthalmology, State University of Rio de Janeiro, Rio de Janeiro, Brazil.
authors.forename: Lucas M M
authors.initials: LM
authors.lastname: Vianna
authors.forename: Fasika
authors.initials: F
authors.lastname: Woreta
authors.forename: Amanda E
authors.initials: AE
authors.lastname: Kiely
authors.forename: Albert S
authors.initials: AS
authors.lastname: Jun
mesh_terms: D000328:Adult; D063171:Corneal Pachymetry; D057112:Corneal Perforation / Q000473:pathology; D019781:Corneal Topography; D016039:Corneal Transplantation / Q000379:methods*; D003886:Descemet Membrane / Q000473:pathology*; D006801:Humans; D007640:Keratoconus / Q000601:surgery*; D015948:Keratoplasty, Penetrating / Q000379:methods*; D008297:Male; D014019:Tissue Donors; D041623:Tomography, Optical Coherence; D014792:Visual Acuity / Q000502:physiology