We read with interest the article by Balachandran and associates reporting on 2 cases of spontaneous corneal clearance despite graft detachment in Descemet membrane endothelial keratoplasty. In our experience, we also had a case whereby an 86-year-old man with cataract and a distant uncorrected visual acuity (UCVA) of 6/60 in his right eye underwent extracapsular cataract extraction (ECCE) in June 2008. During the procedure, the surgeon accidentally removed almost the entire central Descemet membrane, leaving a 2-mm peripheral rim of Descemet membrane. Postoperatively, there was diffuse stromal edema with hand-movement vision. We managed him conservatively in view of the fact that his general health and age did not allow him to undergo further operation under general anesthesia.

Observing him over a period of 10 months, we noted that his corneal edema gradually cleared, leaving an appearance of crocodile shagreen patches, with the edge of the residual Descemet membrane wrinkled up. His UCVA was 6/60 with a pinhole vision of 6/36 and a near vision of N24.

At 15 months post operation, his vision had remained stable and his cornea did not show evidence of edema.

From our observation, we agree with Balachandran and associates that, contrary to conventional view, Descemet membrane may not be necessary in maintaining optical clarity.