https://doi.org/10.1177/1120672120974271 European Journal of Ophthalmology 1–4 © The Author(s) 2020 Article reuse guidelines: sagepub.com/journals-permissions DOI: 10.1177/1120672120974271 journals.sagepub.com/home/ejo EJO European Journal of Ophthalmology Introduction Existence of Pre-Descemet’s layer (PDL) also known as Dua’s layer (DL) was described in 2013, in a series of experiments on donor cornea, where it was reported to exist as a novel, acellular, well-defined layer in pre-Descemet cornea. 1 It is located centrally (<9 mm diameter) and does not reach the peripheral cornea unlike Descemet’s mem- brane (DM). Its recognition had considerable impact on lamellar corneal surgeries like deep anterior lamellar kera- toplasty (DALK), with more insight about formation of different types of big bubbles during the surgery. 2–6 It has not been physically encountered and reported in the literature during endothelial keratoplasties except Pre-Descemet’s endothelial keratoplasty (PDEK) which involves the separation of PDL along with DM-endothelium as a donor lenticule. 7 Its existence has also been reported in pre-descemetocele where intact PDL provides strength to remaining corneal layers in cases of corneal ulcer and prevents perforation. 8 We here-in, report a patient with pseudophakic bullous keratopathy (PBK) who underwent Descemet stripping automated endothelial keratoplasty (DSAEK), and found to have a distinct, thickened layer in the posterior stroma in central cornea. After collaborat- ing preoperative, intraoperative and postoperative clinical, tomographic and histopathological data, we concluded it to be thickened PDL. Case report A 62-year-old female reported with diminution of vision in her right eye for past 6 to 8 months. The diminution of vision was progressive and was associated with pain, redness, and watering. She had undergone cataract sur- gery in her right eye 1 year back. On clinical evaluation, the uncorrected visual acuity (UCVA) was perception Was it thickened Dua’s layer? Clinical, tomographical, and histopathological correlation: A case report Vijay K Sharma 1 , Rajesh Sinha 2 , Alok Sati 1 and Manisha Agarwal 3 Abstract 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. Keywords Pre-Descemet’s layer, Dua’s layer, pre-descemetocele Date received: 30 May 2020; accepted: 17 October 2020 1 Department of Ophthalmology, Army Hospital Research and Referral, New Delhi, India 2 Dr RP Centre for Ophthalmic Sciences, AIIMS, New Delhi, India 3 Department of Pathology, Army Hospital Research and Referral, New Delhi, India Corresponding author: Rajesh Sinha, Dr RP Centre for Ophthalmic Sciences, AIIMS, 474, RP Centre, Ansari Nagar, New Delhi, 110029, India. Email: sinharaj1@gmail.com 974271EJO 0 0 10.1177/1120672120974271European Journal of OphthalmologySharma et al. case-report 2020 Case report