Comment on the Article: Management of Upside-Down Descemet Membrane Endothelial Keratoplasty: A Case Series

I have read with interest the article by Bardan et al. on “Management of upside‑down Descemet membrane endothelial keratoplasty: A case series”.1 I would like to add a few relevant points pertaining to this article. The authors have reported upside‑down Descemet membrane endothelial keratoplasty (DMEK) grafts to be 5 out of 37 eyes (13%), which is in concurrence to the reported incidence of 0–18%. In case 1, the graft detachment was confirmed on the postoperative day 5, but the subsequent intervention was not taken up until day 20. The reasons for the delay in the intervention were not specified. Grafts detached for a prolonged period are known to show fibrosis and graft shrinkage, which do not allow late successful management.