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Toshida H, Hayashi Y, Ichikawa K. Treatment for Intracorneal Hematoma by Anterior Chamber Gas Tamponade Combined With Keratocentesis. Eye Contact Lens 2023; 49:42-44. [PMID: 36384705 PMCID: PMC9750096 DOI: 10.1097/icl.0000000000000959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2022] [Accepted: 09/16/2022] [Indexed: 11/18/2022]
Abstract
PURPOSE To report a new surgical method for intracorneal hematoma removal using combination of keratocentesis and gas tamponade in the anterior chamber. METHODS We reviewed the clinical course and outcomes of surgical intervention. RESULTS An 82-year-old woman visited our department because of a sudden decline in visual acuity (20/800 on the Snellen chart) in her left eye. We observed neovascularization from the superior corneal limbus and a hematoma near the Descemet membrane, deep in the stroma of the corneal center. Filtered air was injected into the anterior chamber, keratocentesis was performed at four locations from the corneal epithelium through the stroma, and the hematoma was removed from the puncture sites. The corneal hematoma disappeared, and the best-corrected visual acuity reached 20/20 at postoperative month 4. DISCUSSION Combination of keratocentesis and gas tamponade in the anterior chamber is a simple and effective method for removing intracorneal hematomas.
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Affiliation(s)
- Hiroshi Toshida
- Department of Ophthalmology, Juntendo University Shizuoka Hospital, Shizuoka, Japan
| | - Yusuke Hayashi
- Department of Ophthalmology, Juntendo University Shizuoka Hospital, Shizuoka, Japan
| | - Kohei Ichikawa
- Department of Ophthalmology, Juntendo University Shizuoka Hospital, Shizuoka, Japan
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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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Hemorrhagic Descemet Membrane Detachment during Ab Interno Canaloplasty. Case Rep Ophthalmol Med 2019; 2019:3653954. [PMID: 31139482 PMCID: PMC6500600 DOI: 10.1155/2019/3653954] [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: 12/05/2018] [Revised: 03/08/2019] [Accepted: 03/31/2019] [Indexed: 11/17/2022] Open
Abstract
Purpose To describe a Descemet membrane detachment in peripheral cornea after canaloplasty with ab interno approach in glaucoma. Case Report A 60-year-old male with uncontrolled primary open-angle glaucoma (POAG) underwent ab interno canaloplasty in the left eye. The previous corrected visual acuity was 20/400 and intraocular pressure 26 mmHg with maximum medical therapy. There was evidence of minor intrastromal bleeding and limited Descemet membrane detachment during the introduction of intracanalicular viscoelastic. Speculate that the Descemet detachment occurred owing to the excessive pressure while injecting the viscoelastic. A conservative management was decided due to the size of the detachment outside the visual axis. On the first postsurgical day, the slit lamp biomicroscopy confirmed that the paralimbal extension of the pre-Descemet hemorrhage was 3mm and the radial extension was 2mm. Moreover the initial thickness of the pre-Descemet hemorrhage measurement with anterior segment OCT was 0.6mm. The follow-up was done weekly. At 3 months postoperatively, cornea recovered its transparency and morphology and intraocular pressure was 18mmHg with maximum medical therapy. Conclusion Descemet membrane detachment by viscoelastic with partial intrastromal hematoma is a rare complication of the ab interno canaloplasty, which can be managed conservatively if it has not compromised the visual axis and has a limited extension.
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Tractional Descemet's membrane detachment after ocular alkali burns: case reports and review of literature. BMC Ophthalmol 2018; 18:256. [PMID: 30249214 PMCID: PMC6154944 DOI: 10.1186/s12886-018-0924-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2018] [Accepted: 09/18/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Descemet's membrane detachment (DMD) is a rare complication after ocular chemical injury and its pathogenesis remains unclear. In this study, we reported two cases of DMD with traction demonstrated on Anterior segment optical coherence tomography (AS-OCT). CASE PRESENTATION Two patients sustained ocular chemical injury with 50% sodium hydroxide. In both cases, AS-OCT revealed detached Descemet's membrane that was adherent to the underlying iris tissue in the inferior quadrant at 45 days and 34 days after the injury respectively. The first case received intracameral tamponade with 12% C3F8 gas and the second case received corticosteroid and sodium chloride 5% eye drops. However, DMD persisted in both cases. CONCLUSIONS The atypical features of DMD on anterior segment optical coherence tomography in our cases suggested the presence of an inflammatory component caused adhesions and traction of iris to Descemet's membrane and prevented reattachment of DMD even with gas tamponade.
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Lages V, Coelho J, Abreu C, Menéres MJ, Barbosa I. Blood in a Haab Stria. Case Rep Ophthalmol 2018; 9:411-415. [PMID: 30283328 PMCID: PMC6167655 DOI: 10.1159/000492567] [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: 05/03/2018] [Accepted: 07/31/2018] [Indexed: 11/19/2022] Open
Abstract
We describe a case of an asymptomatic and spontaneous intracorneal hemorrhage in an adult with congenital glaucoma and blood collected in a Haab stria.
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Affiliation(s)
- Vânia Lages
- Centro Hospitalar do Porto, Porto, Portugal
- *Vânia Lages, Centro Hospitalar do Porto, Largo do Prof. Abel Salazar, PT-4099-001 Porto (Portugal), E-Mail
| | - João Coelho
- Centro Hospitalar do Porto, Porto, Portugal
- Faculdade de Medicina, Universidade do Porto, Porto, Portugal
| | | | - Maria João Menéres
- Centro Hospitalar do Porto, Porto, Portugal
- Instituto de Ciências Biomédicas Abel Salazar, Porto, Portugal
| | - Irene Barbosa
- Centro Hospitalar do Porto, Porto, Portugal
- Instituto de Ciências Biomédicas Abel Salazar, Porto, Portugal
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Recognizing and Managing Bullous Descemet Detachment Secondary to Accidental Hydroseparation During Phacoemulsification/Cataract Surgery by Relaxing Descemetotomy. Cornea 2018; 37:394-399. [PMID: 29053561 DOI: 10.1097/ico.0000000000001425] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To report a new technique called relaxing Descemetotomy for treatment of bullous Descemet detachment (BDD) secondary to accidental hydroseparation of Descemet membrane (DM) during stromal hydration in cataract surgery. METHODS A clear corneal keratome entry was created close to the limbus extending inward to create a relaxing cut (ab externo relaxing Descemetotomy) on taut DM, thus creating an egress route for supra-Descemetic fluid (SDF). This was followed by pneumodescemetopexy to drain SDF internally. RESULTS Three patients with a history of unsuccessful pneumodescemetopexy and with planar or mildly convex separation of DM without break on anterior segment optical coherence tomography (ASOCT) underwent this procedure. All had successful reapposition of DM clinically and on ASOCT. All showed resolution of stromal edema and improved uncorrected and best-corrected visual acuity postoperatively. CONCLUSIONS Rarely stromal hydration performed with an irrigating cannula positioned too close to the posterior stroma can result in hydroseparation of DM creating BDD, seen intraoperatively as a fluid wave propagating across the posterior aspect of the cornea. Large folds, free mobility, and DM tear classically seen with rhegmatogenous Descemet detachment are not seen clinically or on ASOCT in BDD. Pneumodescemetopexy alone cannot resolve BDD because without a DM tear, SDF cannot evacuate. Combining relaxing Descemetotomy with pneumodescemetopexy allows SDF to drain internally and Descemet detachment to resolve. This technique has numerous advantages over classical venting incisions in terms of ease, preferable limbal location, larger incision size, absence of complications such as visual axis scars, irregular astigmatism, epithelial ingrowth, infectious keratitis, etc.
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Abstract
Introduction: The concept of canaloplasty is to increase aqueous egress through all structures that control the aqueous outflow, such as the trabecular meshwork, Schlemm’s canal, and collector channels, by viscomodulation and by placing of a suture stent into the canal. Clinical studies show canaloplasty to be safe and efficient in lowering the intraocular pressure; however, proper knotting of the tensioning suture is technically challenging and even impossible if circumferential cannulation cannot be achieved; furthermore, protrusion of the suture stent is a potential lifelong risk. Methods: The specific design of the Stegmann Canal Expander allows a permanent expansion of the canal and distension of the trabecular meshwork. Two expanders are implanted on either side of the surgically created ostium of Schlemm’s canal to treat half of the circumferential outflow system. This article describes the technique step by step, provides the clinician with surgical pearls, and highlights the management of adverse events. Results: Technically, implantation of the Stegmann Canal Expander is simple and does not require a long learning curve, compared to placing and knotting a tensioning suture. Most issues are related to the two-flap dissection technique (deep sclerectomy technique) and not to implantation of the Stegmann Canal Expander. Intraocular pressure reduction without medications to the low teens can be achieved. Conclusions: The Stegmann Canal Expander is a novel micro-device that has the potential to make canaloplasty a simplified, more controlled, and reproducible surgical procedure.
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Affiliation(s)
- Matthias C Grieshaber
- Department of Ophthalmology, Glaucoma Service, University Hospital of Basel, Basel, Switzerland
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Spontaneous hemorrhagic Descemet membrane detachment causing pupillary block. Eur J Ophthalmol 2018; 22:819-22. [DOI: 10.5301/ejo.5000164] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/12/2012] [Indexed: 11/20/2022]
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Intracorneal hematoma after canaloplasty and clear cornea phacoemulsification: surgical management. Eur J Ophthalmol 2018; 22:823-5. [DOI: 10.5301/ejo.5000132] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/13/2012] [Indexed: 11/20/2022]
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Wylęgała E, Nowińska A. Usefulness of Anterior Segment Optical Coherence Tomography in Descemet Membrane Detachment. Eur J Ophthalmol 2018; 19:723-8. [DOI: 10.1177/112067210901900506] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- E. Wylęgała
- Department of Ophthalmology, District Railway Hospital
- Nursing Department and Social Medical Issues, Health Care Division, Silesian Medical University, Katowice - Poland
| | - A. Nowińska
- Department of Ophthalmology, District Railway Hospital
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Abstract
Intracorneal hematoma or hemorrhagic descemet detachment is a rare phenomenon. It has been previously described after nonpenetrating glaucoma surgeries such as canaloplasty, viscocanalostomy, and deep sclerectomy. In this report, we describe a rare case of intracorneal hematoma as a yet nondocumented complication after Ahmed glaucoma valve implant surgery.
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Casas-Llera P, Arnalich-Montiel F, Muñoz-Negrete FJ, Rebolleda G. Descemet membranotomy to treat pre-descemet haematoma after deep sclerectomy and anterior segment-OCT related findings: A presentation of two clinical cases. ARCHIVOS DE LA SOCIEDAD ESPANOLA DE OFTALMOLOGIA 2017; 92:44-48. [PMID: 27592158 DOI: 10.1016/j.oftal.2016.07.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/15/2016] [Revised: 06/21/2016] [Accepted: 07/04/2016] [Indexed: 06/06/2023]
Abstract
CASE PRESENTATION An 81 year-old woman and a 63 year-old man developed a pre-Descemet haematoma after deep sclerectomy (DS), the former during the surgery itself and the latter during the early post-operative period. The surgical technique is decribed that led to the evacuation of the haematoma and the preservation of the integrity of trabeculo-Descemet membrane. The anterior-segment OCT findings after surgery are also presented. CONCLUSIONS These are the first reported cases of pre-Descemet haematoma after DS that have been successfully repaired by an ab interno Descemet membranotomy. Surgeons should be aware of this rare, but potentially sight-threatening, complication.
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Affiliation(s)
- P Casas-Llera
- Hospital Universitario Ramón y Cajal, IRYCIS, Universidad de Alcalá, Madrid, España
| | - F Arnalich-Montiel
- Hospital Universitario Ramón y Cajal, IRYCIS, Universidad de Alcalá, Madrid, España
| | - F J Muñoz-Negrete
- Hospital Universitario Ramón y Cajal, IRYCIS, Universidad de Alcalá, Madrid, España
| | - G Rebolleda
- Hospital Universitario Ramón y Cajal, IRYCIS, Universidad de Alcalá, Madrid, España.
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A New Expander for Schlemm Canal Surgery in Primary Open-angle Glaucoma—Interim Clinical Results. J Glaucoma 2016; 25:657-62. [DOI: 10.1097/ijg.0000000000000397] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Alobeidan SA, Almobarak FA. Incidence and management of haemorrhagic Descemet membrane detachment in canaloplasty and phacocanaloplasty. Acta Ophthalmol 2016; 94:e298-304. [PMID: 26687402 DOI: 10.1111/aos.12936] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2015] [Accepted: 10/17/2015] [Indexed: 10/22/2022]
Abstract
PURPOSE To report the incidence and management of haemorrhagic Descemet membrane detachment (HDMD) in canaloplasty and phacocanaloplasty. METHODS This study included 105 eyes of 92 patients with uncontrolled open angle glaucoma who underwent canaloplasty and phacocanaloplasty between 2010 and 2014. Eyes that developed either HDMD or non-HDMD were identified. The main outcome measures were the development of HDMD and non-HDMD, best corrected visual acuity, recovery time after Descemet membrane detachment (DMD), intra-ocular pressure (IOP) and number of antiglaucoma medications. Each eye was managed according to the time of development, type and extent of DMD. RESULTS Ten eyes (9.5%) developed DMD- four eyes underwent canaloplasty (3.8%) and six eyes underwent phacocanaloplasty (5.7%). Three of 10 eyes developed non-HDMD while seven of 10 developed HDMD, the majority of HDMD cases occurred in combination with phacocanaloplasty (five of seven). The non-HDMD eyes resolved completely within 2 weeks without intervention. One eye with HDMD was observed for 2 weeks, before a 15% sulphur hexafluoride (SF6) intracameral injection was given. The patient developed a dense corneal stain that was resolving slowly over 30 months. One eye with HDMD underwent YAG laser membranotomy 2 weeks after being identified, which regained corneal transparency 1 month after treatment, while the remaining five eyes underwent immediate surgical drainage and regained corneal transparency 1 day post-procedure. CONCLUSION HDMD occurred in up to 6.7% in canaloplasty and phacocanaloplasty procedures, mostly during catheter withdrawal and the viscodilation step. Early recognition and management prevented further manipulation.
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Affiliation(s)
- Saleh A. Alobeidan
- Department of Ophthalmology; College of Medicine; King Saud University; Riyadh Saudi Arabia
- Glaucoma Research Chair; King Saud University; Riyadh Saudi Arabia
| | - Faisal A. Almobarak
- Department of Ophthalmology; College of Medicine; King Saud University; Riyadh Saudi Arabia
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Rękas M, Byszewska A, Jünemann A. Reply: To PMID 25450241. J Cataract Refract Surg 2015; 41:1123-4. [PMID: 26049852 DOI: 10.1016/j.jcrs.2015.02.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2015] [Accepted: 02/22/2015] [Indexed: 11/17/2022]
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A new clinico-tomographic classification and management algorithm for Descemet's membrane detachment. Cont Lens Anterior Eye 2015; 38:327-33. [PMID: 25936569 DOI: 10.1016/j.clae.2015.03.012] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2014] [Revised: 03/22/2015] [Accepted: 03/28/2015] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To propose a new clinico-tomographic classification of Descemet's detachment (DD). METHODS Interventional case series of 35 eyes with DD were clinico-tomographically classified as: (1)Rhegmatogenous DD (RDD)-lax, free floating DM secondary to DM tear/hole/dialysis; ASOCT showing undulating linear signal with total length equalling overlying stromal arc length. (2) Tractional DD (TDD)-foreshortened, taut DM with tractional/fibrotic component; ASOCT showing detached DM chord length less than overlying stromal arc length. (3) Bullous DD (BDD)-bulge of DM into AC in absence of DM break or needle puncture break too small to allow egress of contents; ASOCT showing convex signal. (4) Complex DD (CDD)-Complex variants and combinations seen clinically and on ASOCT. RESULTS RDD was most common (n=23), 19 were RDD with tear (post-surgical) treated by observation(n=3)/pneumodescemetopexy(n=16), 2 were RDD with hole due to inadvertent DM perforation in deep anterior lamellar keratoplasty treated by pneumodescemetopexy and fibrin glue, 2 were RDD with dialysis post-Descemetorhexis in Descemet's Membrane Endothelial Keratoplasty, not requiring treatment. TDD (n=4) was treated by relaxing Descemetotomy (n=3) or EK (n=1, poor endothelium); BDD (n=3) with two improving spontaneously; CDD (n=5) treated by refloatation with air (n=3)/EK (n=1)/penetrating keratoplasty (n=1). CONCLUSION Treatment and prognosis of DD varies based on etio-morphology. This classification allows systematic approach for diagnosis, management and prognostication.
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Abstract
PURPOSE Descemet membrane detachment (DMD) is uncommon. It most frequently occurs as a complication of intraocular surgery. The aim of this study was to report a case of DMD after neodymium-doped yttrium aluminum garnet (Nd:YAG) laser capsulotomy in a patient with Fuchs dystrophy. METHODS We describe the case of an 89-year-old man suffering from Fuchs dystrophy, who underwent cataract surgery on his left eye. Three years later, the patient presented with posterior capsule opacification, which was treated using Nd:YAG laser capsulotomy. The day after the procedure, the patient came back for emergency treatment because of an acute reduction in his vision caused by a DMD. RESULTS Fifteen days after an initial treatment involving the injection of air into the anterior chamber coupled with ocular paracentesis, clinical examination revealed a significant improvement in visual acuity, reduction in corneal edema, and reattachment of Descemet membrane. These findings were confirmed using anterior segment optical coherence tomography. CONCLUSIONS To our knowledge, this is the first reported case of DMD after Nd:YAG laser capsulotomy.
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Evacuating a pre-Descemet hematoma through a clear corneal incision during a canaloplasty procedure. J Cataract Refract Surg 2014; 40:1953-7. [DOI: 10.1016/j.jcrs.2014.09.032] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2014] [Revised: 04/16/2014] [Accepted: 05/02/2014] [Indexed: 11/21/2022]
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Abstract
PURPOSES To describe a case of hemorrhagic Descemet membrane detachment following canaloplasty and to discuss its management using neodymium:yttrium-aluminum-garnet (Nd:YAG) laser Descemet membranotomy. METHODS Interventional case report. RESULTS A 71-year-old woman with chronic open-angle glaucoma developed a hemorrhagic Descemet detachment after combined phacoemulsification, intraocular lens insertion, and canaloplasty. The hematoma did not improve with initial expectant management. Two and a half weeks after surgery, the Nd:YAG laser was applied to create a break in the Descemet membrane in the region of the hematoma. The intracorneal blood quickly dissipated into the anterior chamber. Visual acuity improved to 20/20. The endothelial cell count was 2342 cells per square millimeter 4 years after the surgery. Pachymetry did not show any long-term alterations as a result of the Nd:YAG treatment. CONCLUSIONS Hemorrhagic Descemet detachment is an uncommon complication after canaloplasty. Nd:YAG Descemet membranotomy is a successful means of clearing the hematoma and thus can prevent further complications, such as corneal blood staining.
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Lopes-Cardoso I, Esteves F, Amorim M, Calvão-Santos G, Freitas ML, Salgado-Borges J. [Circumferential viscocanalostomy with suture tensioning in Schlemm canal (canaloplasty)-one year experience]. ACTA ACUST UNITED AC 2013; 88:207-15. [PMID: 23726305 DOI: 10.1016/j.oftal.2012.06.021] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2011] [Accepted: 04/08/2012] [Indexed: 11/17/2022]
Abstract
PURPOSE To study the efficacy and the safety of ultrasound biomicroscopy assisted canaloplasty in the treatment of open-angle glaucoma (OAG) METHODS: A prospective study of uncontrolled open-angle glaucoma patients, or patients with cataracts associated with controlled or uncontrolled OAG under maximal medical therapy who had been subjected to canaloplasty alone or combined with cataract surgery, respectively. Complications, Goldmann intraocular pressure (IOP) and mean number of drugs (ND) were evaluated at 1 day, 1 week, 1 month, and every 3 months. RESULTS Thirty five surgeries were performed (11 canaloplasties, 24 phaco-canaloplasties). The mean IOP (mmHg) dropped from 24.5±5.1, in canaloplasty, and from 19.8±6.4, in phacocanaloplasty, preoperatively, to medium-low levels at all follow-up periods (13.5±1.0 and 11.0±4.2, at 1 year in canaloplasty and phaco-canaloplasty, respectively). The number of grugs used dropped from 3.3±0.5 before surgery to less than of 1 in all follow-up periods (0.5±0.8 at 1 year). The complications were 2 microruptures of the trabeculodescemetic window, 5 entries in the collector channels, 5 choroidal space/anterior chamber passages, 10 hyphemas, 3 hypotonies, one peripheral Descemet detachment, one intracorneal hematoma, two peripheral anterior synechia, one internal iris prolapse, and two suture extrusions to the anterior chamber. CONCLUSIONS Ultrasound biomicroscopy assisted Canaloplasty, alone or combined, provided a sustained IOP reduction to medium-low levels, led to a decrease in the number of drugs and had a good safety profile, making this a good alternative to trabeculectomy.
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Affiliation(s)
- I Lopes-Cardoso
- Hospital de S. Sebastião, Centro Hospitalar Entre-Douro-e-Vouga, Santa Maria da Feira, Portugal.
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Moradian K, Daneshvar R, Saffarian L, Esmaeeli H, Hosseinnezhad H. The efficacy of viscocanalostomy for uncontrollable primary open-angle glaucoma in a developing country. Indian J Ophthalmol 2013; 61:71-3. [PMID: 23412524 PMCID: PMC3638329 DOI: 10.4103/0301-4738.107196] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
PURPOSE To evaluate the safety and efficacy of viscocanalostomy in the management of medically uncontrollable primary open-angle glaucoma (POAG) in a developing country. MATERIALS AND METHODS This is a prospective, non-randomized case series of 14 consecutive eyes with medically uncontrollable POAG, all subjected to viscocanalostomy. The main outcome measure was success rate based on the intraocular pressure (IOP) level achieved post-operatively. The procedure was considered a complete success if IOP was less than 21 mmHg without any anti-glaucoma medication. Qualified success was defined as IOP of less than 21 mmHg with anti-glaucoma medication. All patients had a regular follow-up of at least 12 months. RESULTS IOP was reduced from a mean baseline value of 27.9 ± 7.3 mmHg (range: 21-40 mmHg) to a mean final value of 16.0 ± 2.7 mmHg (range: 13-22 mmHg), which was statistically highly significant (P < 0.005). The mean number of pre-operative anti-glaucoma medications was 3.0 ± 0.4 (range: 2-4), which was reduced significantly (P < 0.0001) to 0.3 ± 0.6 (range: 0-2) at the last follow-up visit. One year post-operatively, complete success was achieved in 71% and qualified success was observed in 21.4% of patients, summing up to an overall success rate of 92.4%. There were no major complications in any of the patients. CONCLUSION Viscocanalostomy could be performed effectively and safely for control of POAG in developing countries.
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Affiliation(s)
- Khodadad Moradian
- Department of Ophthalmology, Islamic Azad University of Medicine, Mashhad Branch, Mashhad, Iran
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Li YH, Shi JM, Fan F, Duan XC, Jia SB. Descemet membrane detachment after trabeculectomy. Int J Ophthalmol 2012; 5:527-9. [PMID: 22937519 DOI: 10.3980/j.issn.2222-3959.2012.04.24] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2012] [Accepted: 07/17/2012] [Indexed: 11/02/2022] Open
Abstract
Descemet's membrane detachment (DMD) can be a potentially serious complication of intraocular surgery or ocular trauma. The cause is not very clear. We are trying to remind an awareness of the spectrum of DMD resulting from trabeculectomy by presenting a case of extensive DMD after trabeculectomy which was successfully repaired.
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The benefit of ultrasound biomicroscopy (UBM) in management of total Descemet's membrane detachment after deep sclerectomy surgery. Int Ophthalmol 2011; 31:345-8. [PMID: 21858508 DOI: 10.1007/s10792-011-9462-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2010] [Accepted: 07/08/2011] [Indexed: 10/17/2022]
Abstract
The purpose of this study is to report the importance of ultrasound biomicroscopy (UBM) in the diagnosis of Descemet's membrane detachment (DMD) and the efficacy of sulfur hexafluoride (SF6) gas in its management. DMD was identified by UBM in a 22-year-old woman with juvenile glaucoma who underwent deep sclerectomy surgery and developed severe corneal oedema postoperatively. SF6 gas 15% was injected into the anterior chamber. The procedure resulted in reattachment of Descemet's membrane and a completely clear cornea. DMD can be easily overlooked or misdiagnosed after non-penetrating glaucoma surgery. UBM is helpful in diagnosis and management of DMD and descemetopexy with SF6 gas can give good results.
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Abstract
PURPOSE To report a case of an intracorneal hematoma after canaloplasty. METHODS Interventional case report of a surgical method used to resolve an intracorneal hematoma complication after canaloplasty. RESULTS A 45-year-old man with uncontrolled pigmentary open-angle glaucoma underwent canaloplasty for glaucoma in the left eye. The patient previously underwent radial keratotomy for myopia in the same eye in 1997. Visual acuity was 20/20 without corrective lenses; intraocular pressure was 25 mm Hg with maximal medical therapy. During the surgical procedure, the canaloplasty microcatheter encountered an obstacle at the 6-o'clock position. During catheterization, a high-weight viscoelastic substance is normally injected in the canal. This probably caused a limited detachment of the Descemet membrane. On the day after surgery, slit-lamp biomicroscopy showed a large intracorneal hematoma that threatened the visual axis. A partial-thickness paracentesis was then performed on day 2 to remove the hematoma. CONCLUSIONS Intracorneal hematoma is a rare complication of canaloplasty for glaucoma. The blood can be removed without interrupting the Descemet membrane by partial-thickness paracentesis.
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Abstract
Nonpenetrating glaucoma surgeries have been developed in recent years in order to improve the safety of conventional filtering procedures. The goal of nonpenetrating filtering procedures is to reduce intraocular pressure by enhancing the natural aqueous outflow channels, while reducing outflow resistance located in the inner wall of the Schlemm's canal and the juxtacanalicular trabecular meshwork. In the last few years viscocanalostomy and deep sclerectomy with external trabeculectomy have become the most popular nonpenetrating filtering procedures. Both involve removal of a deep scleral flap, the external wall of Schlemm's canal and corneal stroma behind the anterior trabeculum and Descemet's membrane, thus creating an intrascleral space. The aqueous humour leaves the anterior chamber through the intact trabeculo-Descemet's membrane into the scleral space, from where it will egress into different pathways. The technique is associated with a long learning curve. Published clinical trials comparing nonpenetrating glaucoma surgery to full-thickness trabeculectomy have a consensus on the superior safety profile of nonpenetrating glaucoma surgery but are not in agreement when it comes to efficacy, where conflicting results have been found. This article reviews the nonpenetrating surgical techniques, mechanisms of action, indications, contraindications, complications, and results.
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Jeng BH, Meisler DM. A Combined Technique for Surgical Repair of Descemet’s Membrane Detachments. Ophthalmic Surg Lasers Imaging Retina 2006; 37:291-7. [PMID: 16898389 DOI: 10.3928/15428877-20060701-05] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND AND OBJECTIVE Descemet's membrane detachments are an uncommon complication after cataract surgery that can result in severe visual loss. A combined technique of intracameral gas injection and transcorneal suturing for the repair of Descemet's membrane detachments is described. PATIENTS AND METHODS In this interventional case series, four cases of Descemet's membrane detachments with associated corneal edema observed following cataract surgery were successfully repaired using a combined technique of intracameral gas injection and transcorneal suturing. RESULTS In all cases, Descemet's membranes were successfully reattached using the aforementioned technique. In three cases, the associated corneal edema resolved postoperatively. In the fourth case, the patient required a penetrating keratoplasty for persistent corneal edema despite immediate anatomical success following reattachment. CONCLUSIONS Combined intracameral gas and transcorneal suturing appears to be an effective technique in the repair of Descemet's membrane detachments. Early intervention may prevent persistent or recurrent corneal edema.
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Affiliation(s)
- Bennie H Jeng
- Cole Eye Institute, Cleveland Clinic Foundation, OH 44195, USA
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Potter J, Zalatimo N. Descemet’s membrane detachment after cataract extraction. ACTA ACUST UNITED AC 2005; 76:720-4. [PMID: 16361034 DOI: 10.1016/j.optm.2005.08.028] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/29/2005] [Indexed: 10/25/2022]
Abstract
BACKGROUND Descemet's membrane detachment is a rare but potentially serious complication of intraocular surgery, most commonly cataract extraction. Small Descemet's membrane detachments typically resolve with topical medical therapy; however, larger detachments require surgical intervention. The most common surgical procedure is a gas-fluid exchange with 20% sulfur hexafluoride (SF6) or 14% perfluropropane (C3F8), which is typically performed at the biomicroscope and is nontoxic to the endothelium. CASE A 77-year-old man underwent phacoemulsification with a posterior chamber lens implantation by clear corneal incision in the left eye. Visual acuity was 20/40 in the left eye 1 month postoperatively with persistent corneal edema. Visual acuity continued to deteriorate to counting fingers (CF), despite the use of topical hyperosmotics and steroids. At 2 months, a scrolled Descemet's membrane detachment was present from the incision site to the central cornea causing extensive edema. Anterior chamber injection of 14% C3F8 successfully reattached Descemet's membrane. Six weeks after surgery, the gas bubble had resolved, the central cornea was clear, and a curvilinear scar was present from 5:00 to 11:00. Visual acuity remained at CF owing to anterior capsular fibrosis. Anterior YAG capsulotomy improved the vision to 20/40. CONCLUSION Descemet's membrane detachment can have a devastating effect on vision. Timely management is imperative to preserve vision. This case shows the successful repair of Descemet's membrane detachment with 14% C3F8 after unsuccessful topical treatment.
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