Spontaneous descemet membrane tear after uneventful big-bubble deep anterior lamellar keratoplasty

Purpose: To report a case of delayed spontaneous Descemet membrane (DM) tear after big-bubble Deep Anterior Lamellar Keratoplasty (DALK). Methods: Uneventful big-bubble DALK was performed on a 29-year-old patient with advanced keratoconus. No injury to DM was noted intraoperatively and in the first postoperative week. On examination after 1 month, the patient presented with tear and partial detachment of Descemet membrane (DMD). Results: Circumscribed eccentric stromal edema, but not DMD, partially resolved after a 3-month observational period. Conclusions: A tear to DM and consecutive DMD may occur spontaneously after big-bubble DALK. Sutural traction and regressing corneal stromal edema may be etiologic factors.