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Rationale: Graft detachment and endothelial cell damages are 2 major concerns for cataract surgeries in cases after Descemet stripping automated endothelial keratoplasty (DSAEK). We invented a simple but innovative method to anchor the DSAEK graft with sutures during the surgery to avoid possible graft detachment. Patient concerns: We present a 59-year-old male who had done DSAEK surgery. Due to progressed blurry vision due to cataract, he underwent sequential cataract surgery 1 year after DSAEK surgery. We applied the method to the patient successfully and the result was satisfying. Diagnosis: Cataract post-DSAEK surgery. Interventions: At the beginning of surgery, we made 4 radial fixation sutures with Nylon 10-0 though cornea-DSAEK graft at paracentral point and then through limbus. The sutures were located at 45°, 135°, 225°, and 315°. At the end of surgery, 4 fixation sutures were removed. Outcomes: The DSAEK graft was kept well attached during and after the surgery. Only low-grade corneal edema was found postoperation. Lessons: We provide this special method and applied it to our patient successfully. By using our method, surgeons can reassure graft adhesion during and after surgery, especially for those need cataract surgery after DSAEK surgery.

Rationale: Descemet's membrane detachment (DMD) may occur during or following cataract surgery, causing corneal edema and visual loss1. The incidence of DMD after phacoemulsification surgery is only approximately 0.5%, and mostly surgical-related. Late onset bilateral spontaneous DMD after sequential uneventful cataract surgeries, is even rarer, and may result from not only surgery itself, but also from an underlying anatomic abnormality 2. Patient concerns: We present a 80 year old female developed bilateral descemet's membrane detachment after sequential uncomplicated cataract surgeries. Diagnosis: Bilateral Descemet's membrane detachment. Interventions: One eye (left eye) was treated with intracameral air injection and the fellow eye (right eye) was treated with medical treatment only. Outcomes: The DMDs were reattached in both eyes after treatment. Surgical intervention accelerated the duration of recovery and there were no significant outcome differences between the right and the left eye. Lessons: Even if there is a large area of DMD with visual axis involvement, conservative treatment with close observation might still provide a satisfactory result if Descemet's membrane is separated from the posterior corneal stroma by ≤1 mm.