Late spontaneous resolution of a double anterior chamber post deep anterior lamellar keratoplasty

Abstract

A 31-year-old healthy male underwent deep anterior lamellar keratoplasty with big-bubble technique for treatment of keratoconus in his right eye. One week after surgery, he presented with detachment of the endothelium-Descemet complex with formation of a double anterior chamber, despite the apparent absence of an intraoperative Descemet membrane rupture. A subsequent intervention with the intent to relocate the corneal graft button was not effective, because the detachment appeared again one day later. The authors hypothesized that, at the time of the stromal dissection with big bubble technique, a small amount of air penetrated into the anterior chamber, creating a false pathway through the trabecular meshwork. The aqueous humor then penetrated the graft flowing through the false pathway, causing the endothelium-Descemet detachment. The persistence of that pathway, even after the intervention of graft repositioning, caused the failure of the latter procedure and persistence of the double chamber. We decided to wait and observe. The double anterior chamber spontaneously resolved in approximately three months.

Keywords: Big-bubble technique; C3F8, perfluoropropane; Deep anterior lamellar keratoplasty; Double anterior chamber; Keratoconus; SF6, sulfur hexafluoride.

Figure 1

Right eye: anterior segment photograph with Scheimpflug camera showing a double anterior chamber.

Figure 2

Right eye: anterior segment photograph with Scheimpflug camera showing spontaneous resolution of the double anterior chamber.

Figure 3

Supposed mechanism of double chamber formation. On the left: false trabecular pathway formation during big bubble dissection. On the right: aqueous humor flows through the trabecular pathway formed during the big bubble dissection.