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Bevara A, Murthy SI. Iatrogenic Descemet membrane detachment in the donor lenticule during Descemet stripping automated endothelial keratoplasty. BMJ Case Rep 2023; 16:e256380. [PMID: 38050390 PMCID: PMC10693850 DOI: 10.1136/bcr-2023-256380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/06/2023] Open
Abstract
A female patient in her 60s presented with an 8-month history of decreased vision in her right eye. She was diagnosed with pseudophakic bullous keratopathy (PBK), and Descemet stripping automated endothelial keratoplasty (DSAEK) surgery was planned. Intraoperative Descemet membrane detachment (DMD) occurred while inserting the lenticule using the Sheets glide technique. The detachment of the Descemet membrane was detected immediately, and air descemetopexy was performed intraoperatively. Postoperatively, the donor lenticule was attached properly to the stromal bed, except for a focal DMD approximately 3 mm in the inferior part of the lenticule. A second descemetopexy was performed 5 days later, resulting in a complete attachment. A DMD in DSAEK lenticule is an extremely rare complication. Early detection and timely intervention with descemetopexy helped achieve a good anatomical and functional outcome.
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Affiliation(s)
- Akhil Bevara
- Shantilal Shanghvi Cornea Institute, LV Prasad Eye Institute, Hyderabad, India
| | - Somasheila I Murthy
- Shantilal Shanghvi Cornea Institute, LV Prasad Eye Institute, Hyderabad, India
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2
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Li YT, Wu WY, Li JY, Chan SY, Ang M, Feng Y. Types of Descemet Membrane Detachment After Ocular Surface Burns: The Factor Long Been Ignored. Cornea 2023; 42:1426-1431. [PMID: 36729715 PMCID: PMC10538613 DOI: 10.1097/ico.0000000000003210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Revised: 10/19/2022] [Accepted: 10/24/2022] [Indexed: 02/03/2023]
Abstract
PURPOSE The aim of this study was to explore types of Descemet membrane detachment (DMD) after ocular surface burns by anterior segment optical coherence tomography. METHODS This is a pilot, case series, observational study. Patients with DMD after ocular surface burns were enrolled. Ophthalmologic examinations were performed in all patients including slit-lamp photography and anterior segment optical coherence tomography. RESULTS Three types of DMDs in 9 eyes of 9 patients with ocular surface burns were identified depending on the detachment components involved with the pre-Descemet layer (PDL). Type A was referred as a taut chord that the PDL and Descemet membrane (DM) detached simultaneously but were remained attached to each other, while type B was identified as a wavy line separated from the stroma by a dark slit that demonstrated the detachment of DM from the PDL and stroma. Type C was defined as the DM detached with or without PDL but they were separated from each other. We found that DM and PDL were detached simultaneously in most condition, with type A in 4 cases, type C in 5 cases, and type B in only 1 case. CONCLUSIONS Our study demonstrated 3 types of DMDs after ocular surface burns and revealed that the limbal involvement and retrocorneal exudations may give clues to DMD in the corresponding areas. DMDs may be neglected for long in patients with extensive limbal involvement in early stages and also play an important role in unstable ocular surface condition until the late stages of conjunctivalization after ocular surface burns.
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Affiliation(s)
- Yuan-Ting Li
- Department of Ophthalmology, Beijing Key Laboratory of Restoration of Damaged Ocular Nerve, Peking University Third Hospital, Beijing, China; and
| | - Wen-Yu Wu
- Department of Ophthalmology, Beijing Key Laboratory of Restoration of Damaged Ocular Nerve, Peking University Third Hospital, Beijing, China; and
| | - Jing-Yi Li
- Department of Ophthalmology, Beijing Key Laboratory of Restoration of Damaged Ocular Nerve, Peking University Third Hospital, Beijing, China; and
| | - Szy-Yann Chan
- Department of Ophthalmology, Beijing Key Laboratory of Restoration of Damaged Ocular Nerve, Peking University Third Hospital, Beijing, China; and
| | - Marcus Ang
- Singapore National Eye Center, Singapore Eye Research Institute, Singapore.
| | - Yun Feng
- Department of Ophthalmology, Beijing Key Laboratory of Restoration of Damaged Ocular Nerve, Peking University Third Hospital, Beijing, China; and
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3
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Dua HS, Freitas R, Mohammed I, Ting DSJ, Said DG. The pre-Descemet's layer (Dua's layer, also known as the Dua-Fine layer and the pre-posterior limiting lamina layer): Discovery, characterisation, clinical and surgical applications, and the controversy. Prog Retin Eye Res 2023; 97:101161. [PMID: 36642673 DOI: 10.1016/j.preteyeres.2022.101161] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Revised: 12/22/2022] [Accepted: 12/28/2022] [Indexed: 01/15/2023]
Abstract
The pre-Descemet's layer/Dua's layer, also termed the Dua-Fine layer and the pre-posterior limiting lamina layer, lies anterior to the Descemet's membrane in the cornea, is 10 μm (range 6-16) thick, made predominantly of type I and some type VI collagen with abundant elastin, more than any other layer of the cornea. It has high tensile strength (bursting pressure up to 700 mm of Hg), is impervious to air and almost acellular. At the periphery it demonstrates fenestrations and ramifies to become the core of the trabecular meshwork, with implications for intraocular pressure and glaucoma. It has been demonstrated in some species of animals. The layer has assumed considerable importance in anterior and posterior lamellar corneal transplant surgery by improving our understanding of the behaviour of corneal tissue during these procedures, improved techniques and made the surgery safer with better outcomes. It has led to the innovation of new surgical procedures namely, pre-Descemet's endothelial keratoplasty, suture management of acute hydrops, DALK-triple and Fogla's mini DALK. The discovery and knowledge of the layer has introduced paradigm shifts in our age old concepts of Descemet's membrane detachment, acute corneal hydrops in keratoconus and Descemetoceles, with impact on management approaches. It has been shown to contribute to the pathology and clinical signs observed in corneal infections and some corneal dystrophies. Early evidence suggests that it may have a role in the pathogenesis of keratoconus in relation to its elastin content. Its contribution to corneal biomechanics and glaucoma are subjects of current investigations.
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Affiliation(s)
- Harminder S Dua
- Larry A Donoso Laboratory for Eye Research, Academic Unit of Ophthalmology and Visual Sciences, University of Nottingham, The Queens Medical Centre, Nottingham University Hospitals, NHS Trust, Nottingham, England, UK.
| | - Rui Freitas
- Larry A Donoso Laboratory for Eye Research, Academic Unit of Ophthalmology and Visual Sciences, University of Nottingham, The Queens Medical Centre, Nottingham University Hospitals, NHS Trust, Nottingham, England, UK; Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Portugal.
| | - Imran Mohammed
- Larry A Donoso Laboratory for Eye Research, Academic Unit of Ophthalmology and Visual Sciences, University of Nottingham, The Queens Medical Centre, Nottingham University Hospitals, NHS Trust, Nottingham, England, UK.
| | - Darren S J Ting
- Larry A Donoso Laboratory for Eye Research, Academic Unit of Ophthalmology and Visual Sciences, University of Nottingham, The Queens Medical Centre, Nottingham University Hospitals, NHS Trust, Nottingham, England, UK.
| | - Dalia G Said
- Larry A Donoso Laboratory for Eye Research, Academic Unit of Ophthalmology and Visual Sciences, University of Nottingham, The Queens Medical Centre, Nottingham University Hospitals, NHS Trust, Nottingham, England, UK; Research Institute of Ophthalmology, Cairo, Egypt.
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4
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Borkenstein AF, Packard R, Dhubhghaill SN, Lockington D, Donnenfeld ED, Borkenstein EM. Clear corneal incision, an important step in modern cataract surgery: a review. Eye (Lond) 2023; 37:2864-2876. [PMID: 36788364 PMCID: PMC10516977 DOI: 10.1038/s41433-023-02440-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Revised: 12/29/2022] [Accepted: 02/01/2023] [Indexed: 02/16/2023] Open
Abstract
A clear corneal incision (CCI) is the most commonly used entrance site in modern phacoemulsification cataract surgery. Despite some initial concerns about increased endophthalmitis rates through a self-sealing CCI, recent literature suggests that the risk of infection with proper wound construction and all other necessary precautions is minimal. The technique of creating a clear corneal incision has, with recent developments in corneal imaging, undergone critical appraisal leading to a better understanding of incision architecture. Many surgeons operate through smaller incisions, and they have a wide choice of surgical instruments to create their corneal incisions. The aim of this review is to discuss the history and the current status of clear corneal incision creation, the design and materials of surgical blades, and the current trends in manufacturing and sustainability. Although disposable instruments have some advantages and are very popular, recycling, if possible, and avoiding unnecessary plastic waste are important considerations. In any case, the step of CCI is a small one for the surgeon, but a big one for the eye. That is why it has to be done with the utmost precision and in-depth knowledge is important.
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Affiliation(s)
- Andreas F Borkenstein
- Borkenstein and Borkenstein, Private Practice at Privatklinik Kreuzschwestern, Graz, Austria.
| | | | | | - David Lockington
- Tennent Institute of Ophthalmology, Gartnavel General Hospital, Glasgow, UK
| | | | - Eva-Maria Borkenstein
- Borkenstein and Borkenstein, Private Practice at Privatklinik Kreuzschwestern, Graz, Austria
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Orejudo de Rivas M, Martínez Morales J, Pardina Claver E, Pérez García D, Pérez Navarro I, Ascaso Puyuelo FJ, Aramburu Clavería J, Ibáñez Alperte J. Descemet's Membrane Detachment during Phacocanaloplasty: Case Series and In-Depth Literature Review. J Clin Med 2023; 12:5461. [PMID: 37685527 PMCID: PMC10488042 DOI: 10.3390/jcm12175461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Revised: 08/17/2023] [Accepted: 08/20/2023] [Indexed: 09/10/2023] Open
Abstract
This article presents three cases of Descemet's membrane detachment (DMD) occurring during 'ab externo' phacocanaloplasty procedures in three patients with uncontrolled primary open-angle glaucoma (OAG) and discusses the management of this condition by reviewing the available literature. Following a successful 360° cannulation of Schlemm's canal (SC), the microcatheter was withdrawn while an ophthalmic viscosurgical device (OVD) was injected into the canal. During passage through the inferonasal quadrant, a spontaneous separation of the posterior layer of the cornea was observed. Each case was managed differently after diagnosis, with the third case being drained intraoperatively based on experience gained from the previous cases. On the first postoperative day, slit-lamp biomicroscopy (BMC) revealed multiple DMDs in case one and a hyphema in the lower third of a deep anterior chamber. In the other two cases, a single DMD was observed. The second case developed hemorrhagic Descemet membrane detachment (HDMD), while the other two were non-hemorrhagic. In all three cases, anterior segment optical coherence tomography (AS-OCT) revealed the presence of retrocorneal hyperreflective membranes indicative of DMDs. These membranes were located in the periphery of the cornea and did not impact the visual axis. After evaluation, a small incision was made in the inferotemporal DMD of the first case. However, for the two remaining cases, a strategy of watchful waiting was deemed appropriate due to the location and size of the DMDs, as they did not affect the best-corrected visual acuity (BCVA). Over time, the patients demonstrated progressive improvement with a gradual reduction in the size of the DMDs.
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Affiliation(s)
- Marta Orejudo de Rivas
- Department of Ophthalmology, Lozano Blesa University Clinic Hospital, 50009 Zaragoza, Spain (F.J.A.P.); (J.I.A.)
| | - Juana Martínez Morales
- Department of Ophthalmology, Lozano Blesa University Clinic Hospital, 50009 Zaragoza, Spain (F.J.A.P.); (J.I.A.)
| | - Elena Pardina Claver
- Department of Ophthalmology, Lozano Blesa University Clinic Hospital, 50009 Zaragoza, Spain (F.J.A.P.); (J.I.A.)
| | - Diana Pérez García
- Department of Ophthalmology, Lozano Blesa University Clinic Hospital, 50009 Zaragoza, Spain (F.J.A.P.); (J.I.A.)
| | - Itziar Pérez Navarro
- Department of Ophthalmology, Lozano Blesa University Clinic Hospital, 50009 Zaragoza, Spain (F.J.A.P.); (J.I.A.)
| | - Francisco J. Ascaso Puyuelo
- Department of Ophthalmology, Lozano Blesa University Clinic Hospital, 50009 Zaragoza, Spain (F.J.A.P.); (J.I.A.)
- Aragon Health Research Institute (IIS Aragon), 50018 Zaragoza, Spain
- Department of Surgery, School of Medicine, University of Zaragoza, 50009 Zaragoza, Spain
| | - Julia Aramburu Clavería
- Department of Ophthalmology, Lozano Blesa University Clinic Hospital, 50009 Zaragoza, Spain (F.J.A.P.); (J.I.A.)
| | - Juan Ibáñez Alperte
- Department of Ophthalmology, Lozano Blesa University Clinic Hospital, 50009 Zaragoza, Spain (F.J.A.P.); (J.I.A.)
- Aragon Health Research Institute (IIS Aragon), 50018 Zaragoza, Spain
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Li Z, Gao W, Yang Y, Liang W. Diagnosis and treatment of traumatic Descemet's membrane detachment: A case series. Medicine (Baltimore) 2023; 102:e34121. [PMID: 37352059 PMCID: PMC10289586 DOI: 10.1097/md.0000000000034121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2023] [Accepted: 06/07/2023] [Indexed: 06/25/2023] Open
Abstract
RATIONALE The Descemet layer is a dense layer of tissue that does not detach under normal circumstances. Descemet layer detachment may occur after intraocular surgery, but the Descemet layer spontaneously detached after trauma in this child, which is relatively rare. After looking for the cause, we found that the child was diagnosed with congenital glaucoma, and the trauma induced the Descemet's membrane detachment. PATIENT CONCERNS The parents of the patient expected the child to recover the normal shape of the cornea as soon as possible, improve vision, and solve the problem of congenital glaucoma. DIAGNOSES The patient was diagnosed with Descemet's membrane detachment of the left eye and congenital glaucoma in both eyes. INTERVENTIONS During operation, inflation gas is injected into the anterior chamber, the Descemet's membrane is reset, and glaucoma surgery is performed. OUTCOMES The Descemet's membrane in the child's eye was reset, and after glaucoma surgery, the intraocular pressure of the child was normal. LESSONS The analysis of the disease is not only to solve the problems seen but also to deeply analyze the internal causes and pathological changes in combination with the symptoms and signs, so as to discover the essence of the problem and solve the fundamental problem of the patient.
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Affiliation(s)
- Zhao Li
- Ophthalmic Center, General Hospital of Xinjiang Military Region, Urumqi, China
| | - Wen Gao
- Ophthalmic Center, 474 Hospital of Xinjiang, Urumqi, China
| | - Yongli Yang
- Ophthalmic Center, 474 Hospital of Xinjiang, Urumqi, China
| | - Weilin Liang
- PLA General Hospital Jingxi Medical Area, Beijing, China
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7
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Sharma A, Sharma R, Kulshreshta A, Nirankari VS. Double bubble pneumo-descemetopexy for the management of Descemet membrane detachment: An innovative technique. Indian J Ophthalmol 2023; 71:2234-2236. [PMID: 37202957 PMCID: PMC10391505 DOI: 10.4103/ijo.ijo_1623_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/20/2023] Open
Abstract
A 62-year-old woman was referred with poor vision following manual small incision cataract surgery. On presentation, the uncorrected distance visual acuity in the involved eye was 3/60, whereas slit-lamp examination revealed a central corneal edema with the peripheral cornea relatively clear. Direct focal examination with a narrow slit upper border and lower margin of detached rolled up Descemet's membrane (DM) could be visualized. We performed a novel surgical approach, "double-bubble pneumo-descemetopexy." The surgical procedure included unrolling of DM with "small air bubble" and descemetopexy with "big bubble." No postoperative complications were observed, and best corrected distance visual acuity improved to 6/9 at 6 weeks. The patient had a clear cornea and maintained BCVA 6/9 during 18 months at follow-up. Double-bubble pneumo-descemetopexy, a more controlled technique, provides a satisfactory anatomical and visual outcome in DMD without the need for endothelial keratoplasty (Descemet's stripping endothelial keratoplasty or DMEK) or penetrating keratoplasty.
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Affiliation(s)
- Ashok Sharma
- Director, Dr Ashok Sharma's Cornea Centre, Chandigarh, India
| | - Rajan Sharma
- Cornea Service, Dr Ashok Sharma's Cornea Centre, Chandigarh, India
| | - Ashish Kulshreshta
- Associate, Cornea Service, Dr Ashok Sharma's Cornea Centre, Chandigarh, India
| | - Verinder S Nirankari
- Department of Ophthalmology, University of Maryland, College Park, Maryland, USA
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8
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Sherif NA, Fleischman D, Knight OJ. Unintentional Descemet Cleft Introduces Novel Mechanism of Maintenance of Corneal Clarity. Cornea 2023; 42:113-115. [PMID: 35942525 DOI: 10.1097/ico.0000000000003099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Accepted: 06/01/2022] [Indexed: 11/26/2022]
Abstract
PURPOSE The purpose of this study was to report a case of corneal transparency for 7 months after the formation and persistence of a Descemet fluid cleft. METHODS We report the case of a 64-year-old woman undergoing anterior chamber reformation 2 months after Baerveldt implantation of the right eye. During the procedure, the ophthalmic viscoelastic was inadvertently injected into the posterior stroma, nearly isolating the corneal endothelial cell layer, and creating a Descemet fluid cleft filled with viscoelastic. The patient was managed conservatively and monitored near monthly for corneal decompensation. RESULTS The cornea remained centrally clear for 207 days after the initial anterior chamber reformation until the collapse of the viscoelastic cleft. When the cleft completely collapsed, the cornea became diffusely edematous, and the patient underwent cataract removal and intraocular lens placement without need for Descemet stripping endothelial keratoplasty to maintain vision. During these 7 months, the patient's best-corrected visual acuity remained stable at 20/25 +2 or better. Intraocular pressure was also stable, averaging 18.2 mm Hg. CONCLUSIONS We hypothesize that corneal transparency can be maintained in the absence of endothelial cell function provided that aqueous humor cannot reach the cornea and disrupt the arrangement of the interfibrillar space.
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Affiliation(s)
- Noha A Sherif
- The University of North Carolina School of Medicine, Chapel Hill, NC; and
| | - David Fleischman
- Department of Ophthalmology, The University of North Carolina, Chapel Hill, NC
| | - O'Rese J Knight
- Department of Ophthalmology, The University of North Carolina, Chapel Hill, NC
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Case Report: "Spontaneous Descemet Membrane Detachment". J Clin Med 2022; 12:jcm12010330. [PMID: 36615130 PMCID: PMC9820967 DOI: 10.3390/jcm12010330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2022] [Revised: 12/15/2022] [Accepted: 12/29/2022] [Indexed: 01/03/2023] Open
Abstract
INTRODUCTION We report a case and discuss the clinical characteristics and treatment of spontaneous Descemet membrane detachment (DMD). CASE DESCRIPTION We describe a rare case of spontaneous DMD in a patient with prior anterior uveitis and provide a review of the current literature. A 20-year-old woman with a prior history of anterior uveitis presented with vision loss in the left eye. The slit-lamp examination showed corneal edema secondary to DMD, confirmed by anterior segment optical coherence tomography (AS-OCT). The patient underwent an intracameral injection of 20% sulphur hexafluoride (SF6) with complete resolution of the DMD. Although rare, several cases of spontaneous DMD have been reported in the literature, mostly occurring after intraocular surgery. We searched the Pubmed database (1949-2021) for peer-reviewed publications relevant to the topic of spontaneous DMD. DISCUSSION The pathogenesis of spontaneous DMD is complex and depends on several factors. It can occur due to anatomical anomalies, inflammatory disease, trauma, chemical injuries, and surgical or laser procedures. In most cases, early diagnosis and appropriate management led to resolution.
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Yu T, Dai Z, Peng R, Xiao G, Zhang P, Ma S, Hong J. Axenfeld-Rieger syndrome: a novel histopathologic finding associated with corneal abnormalities. BMC Ophthalmol 2022; 22:514. [PMID: 36577962 PMCID: PMC9798569 DOI: 10.1186/s12886-022-02754-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2022] [Accepted: 12/21/2022] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Axenfeld-Rieger syndrome (ARS) is a rare kind of anterior segment dysgenesis (ASD). The most common ocular features of ARS are posterior embryotoxon and iris hypoplasia, while some patients may manifest as corneal opacity and edema. However, the current understanding of how ARS affects the cornea is still incomplete. This study reports a novel histopathological finding of ARS, complicating corneal abnormalities, including congenital corneal opacity and irreversible endothelial decompensation. METHODS This retrospective study included 6 eyes of 3 ARS patients, 5 of which underwent keratoplasty for irreversible endothelial decompensation from May 2016 to January 2019. No eye had a history of surgery. We reviewed the data of epidemiology, clinical manifestations and histopathologic examinations. RESULTS Five eyes developed irreversible endothelial decompensation, among which 4 were born with corneal opacity. One eye exhibited transparent cornea but showed a continuous loss of endothelial cells in the absence of surgery and elevated intraocular pressure thereafter. Anterior segment optical coherence tomography photographs showed that anterior synechia existed in the area with corneal opacities, where we found the interlayer splitting of the Descemet membrane inserted by hypoplastic iris and a basement membrane-like structure under a light microscope. CONCLUSION Anterior synechia might be associated with corneal abnormalities in ARS patients. The novel histopathologic finding revealed the internal relation between anterior segment dysgenesis and would help explore the inner mechanism of corneal abnormalities in ARS.
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Affiliation(s)
- Ting Yu
- grid.411642.40000 0004 0605 3760Department of Ophthalmology, Peking University Third Hospital, No. 49 Garden North Road, Haidian 100191 Beijing, China ,grid.411642.40000 0004 0605 3760Beijing Key Laboratory of Restoration of Damaged Ocular Nerve, Peking University Third Hospital, Beijing, China
| | - Zhihao Dai
- grid.411642.40000 0004 0605 3760Department of Ophthalmology, Peking University Third Hospital, No. 49 Garden North Road, Haidian 100191 Beijing, China ,grid.411642.40000 0004 0605 3760Beijing Key Laboratory of Restoration of Damaged Ocular Nerve, Peking University Third Hospital, Beijing, China
| | - Rongmei Peng
- grid.411642.40000 0004 0605 3760Department of Ophthalmology, Peking University Third Hospital, No. 49 Garden North Road, Haidian 100191 Beijing, China ,grid.411642.40000 0004 0605 3760Beijing Key Laboratory of Restoration of Damaged Ocular Nerve, Peking University Third Hospital, Beijing, China
| | - Gege Xiao
- grid.411642.40000 0004 0605 3760Department of Ophthalmology, Peking University Third Hospital, No. 49 Garden North Road, Haidian 100191 Beijing, China ,grid.411642.40000 0004 0605 3760Beijing Key Laboratory of Restoration of Damaged Ocular Nerve, Peking University Third Hospital, Beijing, China
| | - Pei Zhang
- grid.411642.40000 0004 0605 3760Department of Ophthalmology, Peking University Third Hospital, No. 49 Garden North Road, Haidian 100191 Beijing, China ,grid.411642.40000 0004 0605 3760Beijing Key Laboratory of Restoration of Damaged Ocular Nerve, Peking University Third Hospital, Beijing, China
| | - Siyi Ma
- grid.411642.40000 0004 0605 3760Department of Ophthalmology, Peking University Third Hospital, No. 49 Garden North Road, Haidian 100191 Beijing, China ,grid.411642.40000 0004 0605 3760Beijing Key Laboratory of Restoration of Damaged Ocular Nerve, Peking University Third Hospital, Beijing, China
| | - Jing Hong
- grid.411642.40000 0004 0605 3760Department of Ophthalmology, Peking University Third Hospital, No. 49 Garden North Road, Haidian 100191 Beijing, China ,grid.411642.40000 0004 0605 3760Beijing Key Laboratory of Restoration of Damaged Ocular Nerve, Peking University Third Hospital, Beijing, China
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11
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Trindade LC, Attanasio de Rezende R, Bisol T, J Rapuano C. Late Descemet membrane detachment after uneventful cataract surgery. Am J Ophthalmol Case Rep 2022; 29:101783. [PMID: 36632336 PMCID: PMC9827023 DOI: 10.1016/j.ajoc.2022.101783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Revised: 12/14/2022] [Accepted: 12/18/2022] [Indexed: 12/24/2022] Open
Abstract
Purpose To report 5 patients with late Descemet membrane (DM) detachment after uneventful cataract surgery. Observations After a retrospective chart analysis of consecutive patients that developed DM detachment after uneventful cataract surgery, six eyes of five patients were enrolled. In all cases, patients reported good vision initially after cataract surgery. Within days to months, these patients developed late DM detachment with decreased vision. In one patient, the detachment affected both eyes. Filtered air or diluted sulfur hexafluoride were injected in the anterior chamber to tamponade the DM detachment. In five eyes, the cornea cleared after DM reattachment. In two eyes of the same patient, DM reattached spontaneously requiring no further surgical intervention. In one patient, the Descemet failed to reattach and required an endothelial keratoplasty. Conclusion and importance Descemet membrane detachment may occur after uneventful cataract surgery. Filtered air or long-lasting intraocular gas may be used to reattach DM. Spontaneous DM reattachment may also occur and surgeons should be aware of this to avoid unnecessary procedures.
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Affiliation(s)
- Lovaglio Cançado Trindade
- Medical Sciences Medical School–FELUMA, Belo Horizonte, Brazil,Medical Sciences Eye Institute–FELUMA, Belo Horizonte, Brazil,Cançado-Trindade Eye Institute, Belo Horizonte, Brazil,Corresponding author. Rua Manaus 595, São Lucas - 30.150-350, Belo Horizonte, MG, Brazil.
| | - Renata Attanasio de Rezende
- PUC-Rio University, Rio de Janeiro, Brazil,Instituto de Diagnóstico e Terapia Ocular, Rio de Janeiro, Brazil,São Vicente de Paulo Hospital, Rio de Janeiro, Brazil
| | - Tiago Bisol
- PUC-Rio University, Rio de Janeiro, Brazil,Instituto de Diagnóstico e Terapia Ocular, Rio de Janeiro, Brazil,São Vicente de Paulo Hospital, Rio de Janeiro, Brazil
| | - Christopher J Rapuano
- Wills Eye Hospital, Philadelphia, PA, USA,Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, PA, USA
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12
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Eguchi M, Sakaguchi H, Shiraki A, Soma T, Miki A, Nishida K. Treatment of Descemet's membrane detachment after primary Descemet's stripping automated endothelial keratoplasty during surgery using intraoperative optical coherence tomography. Am J Ophthalmol Case Rep 2022; 27:101623. [PMID: 35761877 PMCID: PMC9233229 DOI: 10.1016/j.ajoc.2022.101623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Revised: 05/30/2022] [Accepted: 06/06/2022] [Indexed: 11/04/2022] Open
Abstract
Purpose To present a novel microscope-integrated optical coherence tomography (iOCT)-guided surgical technique wherein Descemet's membrane detachment (DMD), occurring during vitrectomy, was treated intraoperatively in a patient who had previously undergone Descemet's stripping automated endothelial keratoplasty (DSAEK). Observations The surgical technique was performed on a 75-year-old man with a history of DSAEK to intraoperatively treat DMD, which occurred during vitrectomy in the left eye. A fine needle mounted on a syringe was inserted into the supra-Descemet's space under iOCT guidance. The location of the needle was easily identified by its high reflection. The interface fluid was safely aspirated under excellent visualization of the needle tip and the interface. Successful aspiration of the interface fluid was confirmed via iOCT imaging at the end of the surgery. The graft has remained well attached to the cornea throughout the one-year postoperative follow-up. Conclusion and importance iOCT-guided surgical interventions provide a safe and accurate approach for treating intraoperative complications in eyes with a history of DSAEK.
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Descemet Membrane Endothelial Keratoplasty in a Patient With Descemet Membrane Detachment and Rieger-Like Anomaly Associated With Osteogenesis Imperfecta and Mutation in COL1A1. Cornea 2022; 41:e24. [PMID: 35942528 DOI: 10.1097/ico.0000000000002939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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14
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Dong Q, Wu D, Li M, Dong W. Polysaccharides, as biological macromolecule-based scaffolding biomaterials in cornea tissue engineering: A review. Tissue Cell 2022; 76:101782. [PMID: 35339801 DOI: 10.1016/j.tice.2022.101782] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Revised: 03/07/2022] [Accepted: 03/07/2022] [Indexed: 12/13/2022]
Abstract
Corneal-related diseases and injuries are the leading causes of vision loss, estimated to affect over 10 million people worldwide. Currently, cadaveric corneal grafts are considered the gold standard of treatment to restore cornea-related vision. However, this treatment modality faces different challenges such as donor shortage and graft failure. Therefore, the need for alternative solutions continues to grow. Tissue engineering has dramatically progressed to produce artificial cornea implants in order to repair, regenerate, or replace the damaged cornea. In this regard, a variety of polysaccharides such as cellulose, chitosan, alginate, agarose, and hyaluronic acid have been widely explored as scaffolding biomaterials for the production of tissue-engineered cornea. These polymers are known for their excellent biocompatibility, versatile properties, and processability. Recent progress and future perspectives of polysaccharide-based biomaterials in cornea tissue engineering is reviewed here.
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Affiliation(s)
- Qiwei Dong
- School of medicine, University of Electronic Science and Technology of China, Chengdu 610072, Sichuan, China
| | - Dingkun Wu
- Key Laboratory of Solidification Control and Digital Preparation Technology (Liaoning Province), School of Materials Science and Engineering, Dalian University of Technology, Dalian, Liaoning, China, 116024
| | - Moqiu Li
- Center for Cancer Prevention Research, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu 610041, China
| | - Wei Dong
- School of Mathematics Sciences, Shanxi University, Taiyuan 030006, China.
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15
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Fernández López E, Montolío-Marzo S, Ortega Pérez C, Catalán Gómez M, Peris Martínez C, Piá Ludeña JV, Chan E. Descemet stripping only and ripasudil for the treatment of traumatic Descemet's membrane ruptures. Eur J Ophthalmol 2022:11206721221095598. [PMID: 35435049 DOI: 10.1177/11206721221095598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE Descemet´s membrane ruptures (with a discontinuation of Descemet´s membrane and double detached coiled edges) in the context of complicated anterior segment surgery have rarely been described and its management can be challenging. We report a modified Descemet stripping only (DSO) technique associated with ripasudil drops to treat these cases when other techniques fail. METHODS We describe two cases of large Descemet´s membrane detachments associated with Descemet´s ruptures after cataract surgery that did not respond to two SF6 intracameral injections. As the detached Descemet's membrane and coiled edges might have prevented endothelial cell migration, we decided to perform a modified DSO with post-operative ripasudil drops to promote corneal clearance. RESULTS Both cases improved significantly in unaided and best corrected visual acuity (BCVA), corneal clearance and pachymetry, avoiding the need for an endothelial keratoplasty. Endothelial cells were observed on specular microscopy within the area of the descemetorhexis. CONCLUSION DSO with ripasudil drops might be a valuable tool to recover corneal clearance and avoid endothelial keratoplasty in complex Descemet´s membrane detachments with ruptures that do not respond to other treatments.
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Affiliation(s)
| | | | | | | | | | | | - Elsie Chan
- Cornea Unit, 60080Royal Victorian Eye and Ear Hospital, Melbourne, Australia
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16
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Das AK, Panigrahi A, Gupta N. Central and bullous Descemet membrane detachment during cataract wound hydration: an insightful complication in a post-DALK eye. BMJ Case Rep 2022; 15:e249260. [PMID: 35277423 PMCID: PMC8919468 DOI: 10.1136/bcr-2022-249260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/17/2022] [Indexed: 11/04/2022] Open
Abstract
A 54-year-old man, with history of undergoing deep anterior lamellar keratoplasty (DALK) 20 months ago, presented with mature senile cataract in the same eye. While undergoing phacoemulsification, a large, central Descemet membrane detachment (DMD) was noted, separating the donor cornea from the host predescemetic layer. No DM tears were noted. Stromal puncture was done at the graft host junction to reduce the extent of DMD. This was followed by a large intracameral air bubble insertion, which resulted in complete resolution of DMD on the first postoperative day. DMD during hydration of wound is a unique complication to be anticipated while doing cataract surgery in an operated DALK eye.
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Affiliation(s)
- Amit Kumar Das
- Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Arnav Panigrahi
- Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Noopur Gupta
- Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
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17
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Abihaidar N, Garcin T. Traumatic Descemet's membrane detachment in an old penetrating keratoplasty graft for keratoconus. J Fr Ophtalmol 2022; 45:e277-e279. [DOI: 10.1016/j.jfo.2021.09.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2021] [Accepted: 09/08/2021] [Indexed: 11/25/2022]
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18
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Chow JY, Akhtar Ali AN, Bastion MLC. Pneumodescemetopexy With a Lower Concentration of Perfluoropropane (10% C3F8) in Descemet Membrane Detachment. Cureus 2021; 13:e16985. [PMID: 34527463 PMCID: PMC8421232 DOI: 10.7759/cureus.16985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/07/2021] [Indexed: 11/08/2022] Open
Abstract
A 75-year-old man with underlying left eye idiopathic orbital inflammatory disease and bilateral glaucoma suspect with cup disc ratio 0.7 underwent right eye phacoemulsification. Intraoperatively, Descemet tear and Descemet membrane detachment (DMD) occurred. Pneumodescemetopexy with air bubble was performed. His vision remained counting fingers and the cornea was oedematous three weeks after the operation. Anterior segment optical coherence tomography (ASOCT) showed extensive (80%) rhegmatogenous DMD with planar edge and a maximum of 460 micrometers separation from the stroma. Pneumodescemetopexy with low concentration perfluoropropane (10% C3F8) was performed together with postoperative positioning. On day five post-pneumodescemetopexy, his vision improved to 6/9, the cornea cleared with mild Descemet striae, and the gas bubble reduced to 30% fill. There was no DMD detected on ASOCT. His vision remained 6/9 and the residual gas bubble was 15% in the anterior chamber at two weeks post-pneumodescemetopexy. This case report suggests that pneumodescemetopexy with 10% C3F8 successfully reattached the large nonplanar rhegmatogenous DMD.
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Affiliation(s)
- Jun Yong Chow
- Ophthalmology, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, MYS.,Ophthalmology, Hospital Tengku Ampuan Afzan, Kuantan, MYS
| | | | - Mae-Lynn Catherine Bastion
- Ophthalmology, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, MYS.,Ophthalmology, Hospital Universiti Kebangsaan Malaysia, Kuala Lumpur, MYS
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19
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Nair S, Kaur M, Titiyal JS. Intraoperative Optical Coherence Tomography Guided Imaging of Incision-Site Descemet Membrane Dynamics During Phacoemulsification. JAMA Ophthalmol 2021; 139:917-918. [PMID: 34196694 DOI: 10.1001/jamaophthalmol.2021.2104] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Sridevi Nair
- Cornea, Cataract and Refractive Surgery Services, Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Manpreet Kaur
- Cornea, Cataract and Refractive Surgery Services, Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Jeewan Singh Titiyal
- Cornea, Cataract and Refractive Surgery Services, Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
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20
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Dai Y, Luo L, Liu Y. Intraoperative Optical Coherence Tomography Guided Imaging of Incision-Site Descemet Membrane Dynamics During Phacoemulsification-Reply. JAMA Ophthalmol 2021; 139:918. [PMID: 34196696 DOI: 10.1001/jamaophthalmol.2021.2107] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Ye Dai
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Lixia Luo
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Yizhi Liu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
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21
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A Comparative Study between Air Bubble Tamponade Alone versus Air Bubble Tamponade with Internal Fluid Aspiration for Nonplanar Descemet's Membrane Detachment after Phacoemulsification. J Ophthalmol 2021; 2021:9953418. [PMID: 34327013 PMCID: PMC8277505 DOI: 10.1155/2021/9953418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 05/21/2021] [Accepted: 06/26/2021] [Indexed: 11/22/2022] Open
Abstract
Purpose To compare the efficacy of air bubble tamponade alone versus air bubble tamponade with internal fluid aspiration for nonplanar Descemet's membrane detachment after clear corneal incision phacoemulsification. Methods This study is a prospective, intervention, comparative randomised clinical trial, conducted at a private eye centre, Ismailia, Egypt, from March 2019 to March 2020. It contained 30 eyes of 24 patients who had postphacoemulsification nonplanar Descemet's membrane detachment involving the periphery and the central area of the cornea (>50% of the cornea) with corneal oedema. The patients were divided into two groups: group A: patients with nonplanar DMD affecting the central cornea treated by air bubble tamponade only and group B: patients with nonplanar DMD affecting the central cornea treated by air bubble tamponade augmented by internal fluid aspiration. Trial Registration: This trial was registered at www.pactr.org and the identification number for the registry is PACTR202006612296119. Results During the 12-month study period, this study included 30 eyes (24 patients) out of 1356 phaco surgeries with postphacoemulsification nonplanar Descemet's membrane detachment. Six patients had DMD in both eyes, eight patients had DMD in the right eye, and ten patients had DMD in the left eye. All patients have successful surgeries without complications. The calculated incidence rate for visually significant DMD was 2.2% per year. The mean ± SD time interval from cataract surgery to the primary intervention was 4.2 ± 1.1 days. Descemet's membrane was attached in 56.25% of patients in group A (9 out of 16 eyes) and 92.6% of patients in group B (13 out of 14 eyes) with a minimum of one-month follow-up. Conclusion Air descemetopexy combined with the internal fluid aspiration demonstrated to be more efficient than air descemetopexy only to treat Descemet's membrane detachment following phacoemulsification. It should be tried before planning other major surgeries in patients with severe Descemet's membrane detachment.
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22
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Chung W, Jo YJ, Lee JS. Case Series of Descemet Membrane Detachment Associated with Cataract Surgery. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2021. [DOI: 10.3341/jkos.2021.62.6.834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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23
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Al-Shabeeb RS, Almadhi NH, Kirat O. Late-onset spontaneous Descemet's membrane detachment post penetrating keratoplasty in a patient with congenital glaucoma. Saudi J Ophthalmol 2021; 34:218-219. [PMID: 34085020 PMCID: PMC8081090 DOI: 10.4103/1319-4534.310417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 08/06/2020] [Accepted: 08/08/2020] [Indexed: 11/08/2022] Open
Abstract
A 27-year-old female presented with a sudden decrease of vision in the left eye (OS). Ocular history included advanced congenital glaucoma and previous (15 years) bilateral penetrating keratoplasty and cyclophotocoagulation (9 months) in the left eye. The patient had microcystic corneal edema and Descemet's membrane (DM) detachment; imaging confirmed the detachment with no detectable breaks. DM re-attachment was attempted with an intracameral air bubble tamponade. The edema improved 10 days postoperatively and the graft became clear. Late-onset DM detachment following keratoplasty can occur in patients with congenital glaucoma with no history of recent trauma or eye rubbing. The exact mechanism is unknown, but transscleral cyclophotocoagulation may have a causative role. Timely treatment with air injection results in successful anatomic outcomes.
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Affiliation(s)
- Rawan S Al-Shabeeb
- Department of Ophthalmology, Anterior Segment Division, King Khalid Eye Specialist Hospital, Riyadh, Saudi Arabia
| | - Nada H Almadhi
- Department of Ophthalmology, Anterior Segment Division, King Khalid Eye Specialist Hospital, Riyadh, Saudi Arabia
| | - Omar Kirat
- Department of Ophthalmology, Anterior Segment Division, King Khalid Eye Specialist Hospital, Riyadh, Saudi Arabia
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24
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Dai Y, Liu Z, Wang W, Qu B, Liu J, Congdon N, He M, Luo L, Liu Y. Real-Time Imaging of Incision-Related Descemet Membrane Detachment During Cataract Surgery. JAMA Ophthalmol 2021; 139:150-155. [PMID: 33300946 PMCID: PMC7729572 DOI: 10.1001/jamaophthalmol.2020.5396] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022]
Abstract
Question When and how does incision-related Descemet membrane detachment (DMD) occur during cataract surgery? Findings In this case series of 133 patients with cataract, DMD was found in 125 cataract operations (94.0%) and occurred mostly during the phacoemulsification step (69 cases [55.2%]); DMD also increased throughout surgery. Meaning These findings suggest that incision-related DMD mainly occurs during the surgical steps in which the instruments create the greatest friction at the incision site and that severity is associated with the level of ultrasonic energy and length of time of phacoemulsification. Importance Incision-related Descemet membrane detachment (DMD) is a common complication of cataract surgery. Most postoperative severe DMD that leads to corneal decompensation originates from intraoperative incision-related DMD. It is important to determine the incidence, extent, and associated risk factors of intraoperative DMD at each step of surgery to help in formulating precise and effective prevention strategies. Objectives To investigate the intraoperative development of incision-site DMD associated with a 2.2-mm clear corneal incision during cataract surgery and to analyze its associated factors. Design, Setting, and Participants In this case series, consecutive, prospectively enrolled 133 patients with cataract 50 to 90 years of age (133 eyes) undergoing coaxial 2.2-mm clear corneal microincision phacoemulsification with intraocular lens (IOL) implantation between January 1 and March 31, 2019, at Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China, were studied. Exposures Coaxial 2.2-mm clear corneal microincision phacoemulsification with IOL implantation. Main Outcomes and Measures Real-time incidence and extent of intraoperative incision-related DMD at each step of surgery. Results Among 133 patients with cataracts (mean [SD] age, 72.3 [8.1] years; 77 [57.9%] female), DMD was encountered in 125 eyes (94.0%), occurring at the following steps: capsulorrhexis (2 [1.6%]), hydrodissection (7 [5.6%]), phacoemulsification (69 [55.2%]), irrigation-aspiration (44 [35.2%]), and IOL implantation (3 [2.4%]). The extent of DMD increased during the operation (mean [SD] difference between final and initial relative DMD length, 22.8% [1.4%]; 95% CI, 20.0-25.6; P < .001). Associations for the extent of DMD found in multivariate stepwise analyses included time of ultrasonography (β = 0.34; 95% CI, 0.17-0.50; P < .001), equivalent mean ultrasonic power (β = 87.8; 95% CI, 19.1-156.4; P = .01), and the presence of DMD at the anterior and posterior wound margins (coefficient = 16.7; 95% CI, 6.4-26.9; P = .002). Conclusions and Relevance The results of this case series suggest that friction of surgical instruments has the greatest association with incisional DMD. Decreasing ultrasonic energy and phacoemulsification time may reduce the severity of incisional DMD.
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Affiliation(s)
- Ye Dai
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Zhenzhen Liu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Wei Wang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Bo Qu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Jianping Liu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Nathan Congdon
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, Guangdong, China.,Translational Research for Equitable Eye Care, Centre for Public Health, Royal Victoria Hospital, Queen's University Belfast, Belfast, United Kingdom
| | - Mingguang He
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Lixia Luo
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Yizhi Liu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, Guangdong, China
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25
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González AL, Silva F, Barrientos R, Paredes F. Descemet's Membrane Detachment: An Intraoperative Complication in Cataract Surgery with Phacoemulsification. Int Med Case Rep J 2020; 13:673-677. [PMID: 33293873 PMCID: PMC7718970 DOI: 10.2147/imcrj.s283770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Accepted: 11/19/2020] [Indexed: 11/23/2022] Open
Abstract
Descemet’s membrane detachment (DMD) is a complication fundamentally associated with cataract surgery, the subclinical presentation being higher than expected. There are many varied treatments, from simple observation to penetrating keratoplasty. We present a case report of a 78-year-old male patient, without comorbidities, who underwent cataract surgery with phacoemulsification plus intraocular lens implantation in the capsular bag of the left eye. During the intraoperative procedure, he presented a DMD (height of 350 um and length of 3 mm in Zone 1 according to the HELP algorithm), managed with adaptive viscoelastic under the soft-shell technique in the same operative act, injection of iso-expansile SF6 (20%) intracameral plus postural positioning for 2 hours carried out 48 hours after surgery plus intensive topical treatment with hypertonic sodium chloride and steroidal anti-inflammatory drugs. At 72 hours after the operation of the application of the gas bubble, he presented with a transparent cornea and a best-corrected visual acuity of 20/80, which finally for his ophthalmological control at 8 weeks presented definitive resolution of the case in the AS-OCT and with a BCVA of 20/30.
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Affiliation(s)
- Ana Luisa González
- Department of Ophthalmology, Research Department Clínica La Luz, 1148 Lima, Peru
| | - Fermín Silva
- Department of Ophthalmology, Research Department Clínica La Luz, 1148 Lima, Peru
| | - Robinson Barrientos
- Department of Ophthalmology, Research Department Clínica La Luz, 1148 Lima, Peru
| | - Fabricio Paredes
- Department of Ophthalmology, Research Department Clínica La Luz, 1148 Lima, Peru
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26
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Hemorrhagic Descemet's Membrane Detachment in Nonpenetrating Glaucoma Surgery. J Glaucoma 2020; 30:e352-e356. [PMID: 33074965 DOI: 10.1097/ijg.0000000000001721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Accepted: 10/04/2020] [Indexed: 11/25/2022]
Abstract
PURPOSE To describe 5 representative cases of hemorrhagic Descemet's membrane (DM) detachment in glaucoma surgery that had different origins, mechanisms and treatments. METHODS Clinical records of patients that had undergone a nonpenetrating glaucoma surgery, with a diagnosis of hemorrhagic DM detachment were reviewed for demographic data, clinical findings and treatment applied. RESULTS Five patients with hemorrhagic DM detachment were included in this case series. They all had different causes, namely a massive hemorrhage at the end of a canaloplasty procedure, a needling maneuver, autologous blood injection, Swan syndrome, and frequent eye rubbing. Hematoma evacuation was performed in 4 eyes, 1 of them from under the scleral flap of the deep sclerectomy and 3 of them through a surgical or laser perforation in DM. Air tamponade was done in most of these cases. One of these cases required transcorneal suture fixation. One case was observed expectantly. All cases successfully recovered but peripheral corneal stain was persistent in 2 cases. CONCLUSION Hemorrhagic DM detachment is a rare but potential vision-threatening complication in glaucoma surgery. Different mechanisms may cause the bleeding and there are several techniques available to approach this complication. Pre-Descemet hematoma should be drained to avoid permanent corneal stain and air/gas tamponade may help to prevent recurrences.
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27
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Natarajan R, Matai H. Comments on: Descemet membrane detachment. Surv Ophthalmol 2020; 66:149-150. [PMID: 32585165 DOI: 10.1016/j.survophthal.2020.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2020] [Accepted: 06/09/2020] [Indexed: 12/01/2022]
Affiliation(s)
- Radhika Natarajan
- Sankara Nethralaya, Medical Research Foundation, Chennai, Tamil Nadu, India
| | - Hiren Matai
- Sankara Nethralaya, Medical Research Foundation, Chennai, Tamil Nadu, India.
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