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Complicated DMD was defined if any of the following criteria applied: prior penetrating keratoplasty (PKP), corneal thinning, total DMD or persistent DMD after Air\/Gas-Descemetopexy. Causes, surgical management, and clinical outcomes were analyzed. Scheimpflug tomography, anterior segment optical coherence tomography (AS-OCT) and histologic examination were performed to characterize corneas with DMD.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Results<\/jats:title>\n                <jats:p>Fourteen eyes with prior PKP developed spontaneous DMD after 24.2\u2009\u00b1\u200912.9\u00a0years (range\u2009=\u200918\u00a0months \u2013 47\u00a0years, median\u2009=\u200925.7\u00a0years). Complicated DMD without prior PKP was associated in three eyes after cataract surgery and in one eye after infectious keratitis. In cases with previous PKP, AS-OCT demonstrated rupture of Descemet\u2019s membrane (DM) in five eyes and spontaneous reattachment was found in four eyes within 8\u00a0weeks of initial diagnosis, with no rupture of DM in any of the cases. There was no rupture of DM in corneas without previous PKP. After prior keratoplasty, definitive surgical treatment was repeat PKP in 13 eyes and Air\/Gas-Descemetopexy in one eye. In corneas without prior keratoplasty, three eyes underwent PKP and one eye Air\/Gas-Descemetopexy. Histological examination of two corneal explants revealed a severely thinned graft-host junction and a disrupted DM close to the graft-host junction. Visual acuity improved from 1.80\u2009\u00b1\u20090.58 logMAR to 0.75\u2009\u00b1\u20090.69 logMAR after prior PKP and from 1.45\u2009\u00b1\u20090.65 logMAR to 0.85\u2009\u00b1\u20091.13 logMAR without prior PKP. The postoperative course was uneventful in 16 of 18 eyes.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusion<\/jats:title>\n                <jats:p>PKP is an effective treatment option for complicated DMD, especially in ectatic corneas, whereas Air\/Gas-Descemetopexy or Descemet Membrane Endothelial Keratoplasty do not address the primary issue of the curvature anomaly.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1007\/s00417-023-06231-w","type":"journal-article","created":{"date-parts":[[2023,9,8]],"date-time":"2023-09-08T09:02:22Z","timestamp":1694163742000},"page":"879-889","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Surgical management of complicated Descemet\u2019s membrane detachment in corneas without prior endothelial keratoplasty"],"prefix":"10.1007","volume":"262","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2307-2237","authenticated-orcid":false,"given":"Tim","family":"Berger","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Berthold","family":"Seitz","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elias","family":"Flockerzi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shady","family":"Suffo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fidelis A.","family":"Flockerzi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maximilian","family":"Berger","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"N\u00f3ra","family":"Szentm\u00e1ry","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Loay","family":"Daas","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2023,9,8]]},"reference":[{"key":"6231_CR1","doi-asserted-by":"publisher","first-page":"182","DOI":"10.1136\/bjophthalmol-2016-309766","volume":"102","author":"A Odayappan","year":"2018","unstructured":"Odayappan A, Shivananda N, Ramakrishnan S et al (2018) A retrospective study on the incidence of post-cataract surgery Descemet\u2019s membrane detachment and outcome of air descemetopexy. 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Approval was granted by the Ethics Committee of Saarland\/Germany (No. 24\/23).","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval"}},{"value":"All authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest (such as honoraria; educational grants; participation in speakers\u2019 bureaus; membership, employment, consultancies, stock ownership, or other equity interest; and expert testimony or patent-licensing arrangements), or non-financial interest (such as personal or professional relationships, affiliations, knowledge or beliefs) in the subject matter or materials discussed in this manuscript.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflicts of interest"}}]}}