Intentional retention of Descemet's membrane in keratoplasty for the surgical treatment of bullous keratopathy.

We report on a modified keratoplasty procedure performed in 6 patients for the treatment of severe pseudophakic bullous keratopathy. While removing the host's cornea, the Descemet membrane was retained, and a full thickness graft sutured on top of it. Postoperatively, aqueous separated the host's Descemet membrane from the graft, thus forming a supernumerary anterior chamber. The graft remained clear in 5 of these patients during up to 28 months of follow-up. We suggest that in some severely damaged and high risk eyes, where opening the anterior chamber might be associated with difficulties and complications, it could be worthwhile to perform an 'extraocular' procedure by retaining the host's Descemet membrane.