Neodymium:YAG laser optical opening for retained Descemet's membrane after penetrating keratoplasty

A 78-year-old woman who had intracapsular cataract extraction and anterior chamber intraocular lens implantation 8 years earlier presented with decreased visual acuity (20/400) and discomfort of 2 years duration in the operated eye. Penetrating keratoplasty was done to improve visual function and reduce discomfort; however, at 6 months postoperative, visual acuity was 20/800, due in part to retained opacified host corneal tissue. A retrograft (duplicate) membrane was identified at the posterior aspect of the graft/host junction. The neodymium:YAG laser was used to create a central 3.5 mm circular opening in the duplicate membrane. There were no complications from the laser treatment. The donor cornea remained thin and clear, and visual acuity improved to 20/40 with spectacle correction. It is imperative to confirm complete removal of host corneal tissue before implanting donor tissue; however, vision can be restored, and a corneal graft can remain clear following laser membranotomy.