Was it thickened Dua's layer? Clinical, tomographical, and histopathological correlation: A case report

A 62-year-old female developed pseudophakic bullous keratopathy after cataract surgery and underwent Descemet stripping automated endothelial keratoplasty (DSAEK). Intraoperatively, a white opacified pre-Descemet's layer was noticed after scoring and removal of trypan blue stained Descemet's membrane (DM), and endothelium complex. It was removed using internal limiting membrane peeling forceps and sent for histopathological evaluation along with DM-endothelium complex and epithelium. Preoperative, intraoperative, and postoperative clinical, tomographical, and histopathological data confirmed thickened PDL or Dua's layer. This is a rare encounter with scarred PDL or Dua's layer during DSAEK surgery.