Case report of spontaneous corneal clearance after subtotal graft detachment following combined Descemet's membrane endothelial keratoplasty and cataract surgery.

Purpose: Fuchs' Endothelial Corneal Dystrophy (FECD) is a bilateral, sporadic or autosomal dominant, non-inflammatory corneal dystrophy characterized by the progressive loss of corneal endothelial cells. While DMEK has been proven to attain better post-operative best corrected visual acuity (BCVA), it has presented the challenge of more frequent postoperative graft detachments. Methods: In this case report, we describe an event of spontaneous corneal clearance after near subtotal graft detachment noted in the early postoperative period in a patient with FECD who underwent combined DMEK with a 7.5 mm donor graft and intraocular lens placement. Results: On postoperative week 2, the patient presented with count fingers vision, diffuse microcystic edema, and 75 % detachment of the DMEK graft. At postoperative month 6, the patient presented with vision of 20/30, a clear cornea, DMEK graft one fourth attached and folded over on itself in the anterior chamber. Conclusion: Our case highlights spontaneous corneal clearance after more than three-quarters detachment of the donor graft following combined DMEK and cataract surgery. Although we cannot predict long term corneal transparency in our patient, the stability at 6 months implies that there is endothelial cell migration in patients with minimal DMEK graft attachment.