Abstract

We highlight two cases with double descemet membrane (DM) observed in the postoperative period. First case was macular dystrophy planned for DALK. Big-bubble was successfully formed and surgery was completed uneventfully with no intraoperative perforation. On POD 1, a double DM was observed. A type III bubble had formed during big-bubble creation, separating pre-descemetic layer (PDL) from stroma and DM from PDL. iOCT guided management of the case involved creating a nick in the PDL to remove interface air bubble between PDL and DM and allow graft apposition. Second case underwent uneventful penetrating keratoplasty for CHED. Double membranes were observed on POD 1. ASOCT revealed retained host DM, in addition to graft DM. Descemetorhexis was done to peel the retained host DM after staining it with trypan blue. Both cases achieved optimal anatomical apposition, clear grafts with UDVA of 20/40-20/32 at 1 month.