PRK in idiopathic Descemet membrane rupture: case report with 10-year visual and topographic stability

Introduction: This case report presents a successful photorefractive keratectomy (PRK) in an eye with idiopathic Descemet membrane (DM) rupture. This condition traditionally contraindicates corneal refractive surgery due to stromal integrity concerns. This case demonstrates long-term visual and topographic stability in such an atypical scenario. Patient and Clinical Findings: A 28-year-old man presented in May 2014 for refractive surgery evaluation, showing an incidental DM rupture in the right eye with no pathology in the left eye. Baseline assessments showed uncorrected distance visual acuity (UDVA) of 0.3 and corrected distance visual acuity (CDVA) of 1.0 in the right eye, with mild topographic irregularity but no ectasia or endothelial decompensation. Prior FS-LASIK in the left eye (2010) was uneventful. Diagnosis, Intervention, and Outcomes: An idiopathic DM rupture was diagnosed. PRK was performed in July 2014, using 0.02% mitomycin-C. Postoperative UDVA improved to 0.8 at 1 week, 0.9 at 1 month, and CDVA reached 1.2 at 3 months. At 10-year follow-up (November 2024), UDVA was 0.7, CDVA 1.0, with stable topography and no adverse events. Conclusions: PRK can achieve sustained outcomes in healed DM rupture with careful patient selection and planning, expanding traditional refractive surgery eligibility.