Removal of retained descemets membrane using femtosecond laser

Abstract

We present a unique method of retrocorneal membrane removal with a femtosecond laser (FSL). A 22-year-old male who had undergone penetrating keratoplasty had a retained retrocorneal membrane and a double anterior chamber postoperatively. The membrane was dissected completely with the FSL and the free-floating membrane was removed. Histopathological evaluation confirmed the diagnosis of retained Descemets membrane (DM). There was improvement in uncorrected visual acuity from 20/300 to 20/50. Central corneal endothelial cell count was 810 cells/mm2 preoperatively and 778 cells/mm2 postoperatively. Inadvertent retention of DM may be safely treated with the FSL. Clarity and viability of the existing graft can be maintained.

Triamcinolone Acetonide-Assisted Descemetectomy for Retained Descemet Membrane

“…Material within the graft-host interface interferes with tissue adherence, leading to graft detachment and subsequent DM retention. Additionally, corneal edema facilitates DM separation, which may result in membrane detachment during trephination for repeat transplant, which is the likely cause of detachment in our patient [ 9 ].…”

“…Options include the use of neodymium-doped yttrium aluminum garnet (Nd:YAG) laser to create an opening in the membrane within the central visual axis [ 8 ]. May et al [ 9 ] reported a case in whom femtosecond laser was used to dissect the membrane followed by intraocular forceps removal. Nd:YAG-assisted descemetectomy was not recommended in this case due to concern for possible obstruction of glaucoma drainage devices by loose membrane scrolls.…”

“…Visual acuity can be threatened directly by opacification of these retained membranes or secondarily by compromise of endothelial function, leading to graft failure. Various techniques for management have been described previously [ 6 , 7 , 8 , 9 ]. We describe a unique technique for surgical excision of retained DM in a case with prior sequential endothelial keratoplasty and PKP.…”

Femtosecond Laser-Assisted Membranectomy of Retained Host’s Descemet’s Membrane Postpenetrating Keratoplasty

“…The laser guideline was manually refocused on the retained DM instead of the anterior capsule, and the parameters were set as follows: Total energy, 15 μJ; cutting circumference, 5.5 mm; spot separation, 3 μJ; line of separation, 2 μm; gates, 325 μm up and 375 down. [ 6 ] The patient was then transferred to the operating room, where her left eye was prepared and draped as per the standard disinfection protocol. A corneal wound was created, and removal of the retained membrane using intraocular forceps was attempted.…”

“…[ 1 ] Retention of the host’s Descemet’s membrane (DM) is a rare yet significant complication[ 2 ] that can be managed by observation,[ 3 ] direct surgical removal,[ 4 ] and neodymiumdoped yttrium − aluminum garnet (YAG) laser membranotomy;[ 5 ] more recently, the first case of femtosecond laser (FSL)-descemetorhexis was reported. [ 6 ] Herein, we have described two additional cases of DM retention after PKP that were successfully treated by FSL. The procedures were approved by the KKESH research committee (project number, 1868-CR).…”