NEODYMIUM-YAG LASER OPTICAL OPENING FOR RETAINED DESCEMETS-MEMBRANE AFTER PENETRATING KERATOPLASTY

A 78-year-old woman who had intracapsular cataract extraction and ante rior chamber intraocular lens implantation 8 years earlier presented w ith decreased visual acuity (20/400) and discomfort of 2 years duratio n in the operated eye. Penetrating keratoplasty was done to improve vi sual function and reduce discomfort; however, at 6 months postoperativ e, visual acuity was 20/800, due in part to retained opacified host co rneal tissue. A retrograft (duplicate) membrane was identified at the posterior aspect of the graft/host junction. The neodymium:YAG laser w as used to create a central 3.5 mm circular opening in the duplicate m embrane. There were no complications from the laser treatment. The don or cornea remained thin and clear, and visual acuity improved to 20/40 with spectacle correction. It is imperative to confirm complete remov al of host corneal tissue before implanting donor tissue; however, vis ion can be restored, and a corneal graft can remain clear following la ser membranotomy.