To report a case of retained Descemet's membrane after penetrating keratoplasty (PKP).

A 64-year-old man visited our clinic, complaining of visual disturbance and corneal opacity in his right eye 40 years in duration. On the first visit, his best corrected visual acuity was hand movement on the right eye, and he underwent an uneventful PKP. On the postoperative first day, the patient's visual acuity was 20/200 and slit lamp examination showed a retained Descemet's membrane and pseudo-chamber behind the corneal graft. The corneal graft was edematous, but no intraocular inflammation was observed. The retained Descemet's membrane was surgically removed a quarter at a time. Sutures in one quadrant were removed; the retained Descemet's membrane was lifted with forceps, removed with scissors and knife, and then sutured again. Two months after PKP, the corneal graft remained clear and no intraocular inflammation was observed. An extracapsular cataract extraction (ECCE) was then successfully performed with posterior chamber lens implantation for the senile cataract in his right eye. After the 1-year follow-up, the status of the corneal graft remained clear with a single anterior chamber and best corrected visual acuity improved to 20/100.

Careful post-operative slit-lamp examination is considered important for diagnosis of retained Descemet's membrane after undergoing PKP, and surgical removal can be helpful for maintaining the corneal graft clear.