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A patient underwent a left phacoemulsification, intra-ocular lens (IOL) insertion,
and Descemet membrane endothelial keratoplasty (DMEK). The donor tissue had excellent
endothelial cell count and was compliant with regulatory screening protocols. The
donor patient died from hepatic failure and was noted to be severely jaundiced, consistent
with the diffuse yellow tinge found in the corneal stroma. A standard 8 mm DMEK peeling
was initiated uneventfully, with the tissue being more robust and stiffer than normal.
However, the peripheral rim of the DMEK tissue folded in an uncharacteristic petaloid
and then sinusoidal configuration (Fig. 1). The patient had an uncomplicated procedure and is doing well.
Fig. 1Petaloid (A) and sinusoidal “yin and yang” (B) peripheral rim of Descemet membrane
endothelial keratoplasty configuration stained with trypan blue on a background of
a jaundiced stroma.
