Postoperative Descemet Membrane Detachment With Maintenance of Corneal Clarity After Trabeculectomy

Wigginton, Stephen A; Jungschaffer, Dana A.; Lee, David A.

doi:10.1097/00061198-200004000-00014

Cited by 25 publications

(10 citation statements)

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“…The cornea was clear in spite of a large DMD which resolved with conservative treatment in 6 months. [4] Rasouli et al reported a case of DMD following several AC reformations with OVD injection for management of post-trabeculectomy hypotony. This was managed by viscoelastic tamponade, full thickness 10-0 nylon sutures, and drainage of the fluid between the stroma and the DM.…”

Section: Discussionmentioning

confidence: 99%

Descemet's membrane detachment management following trabeculectomy

Sharifipour¹,

Nassiri²,

Aida³

2016

J Ophthalmic Vis Res

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Purpose:To present a case of total Descemet's membrane detachment (DMD) after trabeculectomy and its surgical management.Case Report:A 68-year-old woman presented with large DMD and corneal edema one day after trabeculectomy. Intracameral air injection on day 3 was not effective. Choroidal effusion complicated the clinical picture with Descemet's membrane (DM) touching the lens. Choroidal tap with air injection on day 6 resulted in DM attachment and totally clear cornea on the next day. However, on day 12 the same scenario was repeated with choroidal effusion, shallow anterior chamber (AC), and DM touching the lens. The third surgery included transconjunctival closure of the scleral flap with 10/0 nylon sutures, choroidal tap, and intracameral injection of 20% sulfur hexafluoride. After the third surgery, DM remained attached with clear cornea. Suture removal and needling bleb revision preserved bleb function. Lens opacity progressed, and the patient underwent uneventful cataract surgery 4 months later.Conclusion:Scleral flap closure using transconjunctival sutures can be used for DMD after trabeculectomy to make the eye a closed system. Surgical drainage of choroidal effusions should be considered to increase the AC depth.

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Section: Discussionmentioning

confidence: 99%

Descemet's membrane detachment management following trabeculectomy

Sharifipour¹,

Nassiri²,

Aida³

2016

J Ophthalmic Vis Res

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“…[ 5 ] Surgical trauma is the predisposing factor in DMD and this complication has been reported after iridectomy, extracapsular cataract extraction, phacoemulsification, viscocanalostomy, trabeculectomy, iridectomy, penetrating keratoplasty and cyclodialysis. [ 1 2 3 4 5 6 ] Inadvertent insertion of instruments between the corneal stroma and Descemet's membrane, improper incisions (excessively anterior or shelved incisions), too tight or too long corneal tunnels, use of dull knifes, engagement of Descemet's membrane during intraocular lens implantation or misuse of the irrigation/aspiration devices are among predisposing factors for DMD. [ 1 2 3 4 5 6 11 ]…”

Section: Discussionmentioning

confidence: 99%

“…Descemet's membrane detachment (DMD) or tears may occur as a complication of intraocular procedures; causes of this condition include cataract surgery, viscocanalostomy, trabeculectomy, iridectomy, penetrating keratoplasty and cyclodialysis. [ 1 2 3 4 5 6 ] DMD may manifest with loss of vision due to corneal edema and the presence of Descemet's membrane (DM) folds. The incidence of DMD has been reported from 2% to 6% and from 0% to 5% during extracapsular and phacoemulsification catatact surgery, respectively.…”

Section: Introductionmentioning

confidence: 99%

Complex descemet′s membrane tears and detachment during phacoemulsification

Oruçoğlu¹,

Aksu²

2015

J Ophthalmic Vis Res

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Purpose:To report a case of complex Descemet's membrane detachment (DMD) and tears during phacoemulsification cataract surgery.Case Report:A 64-year-old woman underwent phacoemulsification surgery in her right eye and developed tears and partial loss of Descemet's membrane (DM) while the aspiration port was inserted through the main incision. Massive corneal edema obscured the view and the anterior chamber was barely visible the following day. Scheimpflug imaging was used to complement slit lamp examination in the postoperative period. Frequent topical corticosteroid drops were initiated. After 5 days of treatment, multiple tears and detachment of DM were visible and the anterior chamber was filled with air. After 5 weeks, the cornea regained much of its clarity despite large DM tears and focal loss of DM.Conclusion:Despite partial loss of DM, the corneal edema mostly disappeared after 5 weeks of air bubble injection. Scheimpflug imaging was beneficial in the diagnosis and monitoring of DM tears and detachments.

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“…Similar cases of clear corneas after DMD have been reported. 7,8 We recommend using SL-OCT to evaluate patients with DMD and reduced biomicroscopic view as it may provide accurate information about the location, size, and extent of the detachment that might not be possible with slit-lamp biomicroscopy. …”

Section: Commentmentioning

confidence: 99%