Non-resolving Descemet folds 2 years following deep anterior lamellar keratoplasty: the impact on visual outcome

We describe 2 case reports of keratoconus patients showing Descemet's folds persisting more than 2 years after deep anterior lamellar keratoplasty (DLK). One patient had worse best corrected visual acuity postoperatively whereas the other did not improve beyond 6/24. We attribute this to the Descemet's folds. We believe the latter to be a complication following DLK consequent to the degree of localised corneal tissue expansion that may occur in advanced keratoconus in a pathological setting. We also discuss possible mechanisms to try to prevent such a complication.