Hemorrhagic Descemet Membrane Detachment during Ab Interno Canaloplasty

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.

Bedside anterior segment optical coherence tomography-assisted reattachment of severe hemorrhagic Descemet’s membrane detachment after ab externo 360-degree suture trabeculotomy combined with trabeculectomy

“…Jaramillo et al [10] reported a 7.4% incidence of DMD in 162 eyes after canaloplasty, half of which were associated with intracorneal haemorrhage, and do not typically affect visual acuity and intervention is not needed. And localized HDD has also been reported in up to 6.7% of cases, mostly located in the inferior or inferonasal cornea and surgical intervention is usually not needed [11] . Although the best timing and management approach to HDD and intracorneal hematoma remain controversial, most authors agree that the blood should be drained to avoid deterioration of vision.…”

Newly Modified Descemetopexy Method in Descemet’s Membrane Detachment and Prognostic Analysis: A Systematic Review

“…[7] [8][9]. During intraocular surgeries, ingress and egress of the instrument can cause Descemet's membrane (DM) contusion and even detachment from the edge of the incision[2] [9][10]. Corneal endothelial cells adhere to the posterior surface of DM, conducting an important dehydrating function to maintain the transparency of the cornea[2] …”