To report a case of double descemet membrane forming a double anterior chamber following ‘Big bubble’ DALK converted to PKP.

A 52-year-old man with keratoconus underwent DALK operation converted to PKP due to macro perforation of the descemet membrane. On the postoperative evaluation a remnant of the host's descemet membrane formed a double anterior chamber. After a few months with no intervention, an attempt to deflect a thickened descemet membrane had failed, making entrance into the anterior chamber in order to excise the membrane inevitable. Two years following the second surgery a graft endothelial failure and cataract formation was documented, leading to a second corneal transplantation and lens implantation.

Double DM is an unusual condition following a DALK procedure which was converted into PKP. In the above case this complication resulted in multiple procedures and graft failure. We believe that early interventions such as gas injection or YAG laser could have resulted in a more favorable outcome.

Graffi S, Naftali M. Double Descemet Membrane Forming a Double Anterior Chamber. J Kerat Ect Cor Dis 2013;2(3):129-132.