Venting incision of cornea and intracameral air repairs Descemet membrane detachment three months after phacoemulsification surgery

Introduction: Cataract surgery is one of the most commonly performed operations in the world. Descemet membrane detachment (DMD) is a potentially blinding complication of this operation. Aim: To describe the successful treatment of DMD three months after initial surgery. Case study: Retrospective case review. Results and discussion: A 69-year-old bilateral pseudophakic man presented with persistent blurring of vision in his left eye despite having undergone left eye cataract surgery for phacomorphic glaucoma 10 weeks previously. Examination and anterior segment optical coherence tomography (AS-OCT) showed left descemet detachment involving the visual axis. Despite the long duration, he underwent left cornea venting incision combined with intracameral air injection which successfully improved the cornea clarity and reattached the descemet on AS-OCT. When this was combined with treatment for cystoid macula oedema, he was able to attain best corrected visual acuity of 6/6-2, N5 3 months after the cornea venting procedure. Conclusions: Treatment with cornea venting incision combined with air injection is an effective method of reattaching the descemet membrane in late presentation of DMD.

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Hemorrhagic Descemet Membrane Detachment during Ab Interno Canaloplasty

Case Reports in Ophthalmological Medicine ◽

10.1155/2019/3653954 ◽

2019 ◽

Vol 2019 ◽

pp. 1-4

Author(s):

Juan Carlos Izquierdo Villavicencio ◽

Josefina A. Mejías Smith ◽

Laura A. Cañola Ramírez ◽

Natalia Agudelo Arbelaez ◽

Bárbara Rubio Lastra

Keyword(s):

Intraocular Pressure ◽

Medical Therapy ◽

Open Angle Glaucoma ◽

Rare Complication ◽

Anterior Segment ◽

Visual Axis ◽

Excessive Pressure ◽

Descemet Membrane ◽

Ab Interno ◽

Descemet Membrane Detachment

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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Treatment of Inferior Descemet Membrane Detachment Secondary to Cataract Surgery with Air Injection and Supine Head Position

Seminars in Ophthalmology ◽

10.3109/08820538.2011.622338 ◽

2012 ◽

Vol 27 (1-2) ◽

pp. 22-24 ◽

Cited By ~ 1

Author(s):

George D. Kymionis ◽

Georgios A. Kontadakis ◽

Argyro D. Plaka ◽

Miltiadis K. Tsilimbaris

Keyword(s):

Cataract Surgery ◽

Head Position ◽

Air Injection ◽

Descemet Membrane ◽

Descemet Membrane Detachment

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Clinical characteristics and treatment of secondary glaucoma, glaucoma suspects and ocular hypertension after congenital cataract surgery

European Journal of Ophthalmology ◽

10.1177/1120672121991356 ◽

2021 ◽

pp. 112067212199135

Author(s):

Katharina Eibenberger ◽

Barbara Kiss ◽

Ursula Schmidt-Erfurth ◽

Eva Stifter

Keyword(s):

Intraocular Pressure ◽

Cataract Surgery ◽

Ocular Hypertension ◽

Congenital Cataract ◽

Case Series ◽

Secondary Glaucoma ◽

Visual Axis ◽

Retrospective Case ◽

Pediatric Cataract ◽

Congenital Cataract Surgery

Objective: To evaluate changes in intraocular pressure after congenital cataract surgery in a real-world setting. Methods: This retrospective case series included all children aged 0–2 years undergoing lens extraction due to congenital cataract. Development of an elevated intraocular pressure was divided into three groups: secG, suspG and OHT. Further, risk factors for IOP changes, the therapeutic approach and functional outcome were assessed during follow-up. Results: One hundred and sixty-one eyes of 110 patients aged 0–2 years were included, whereof 29 eyes of 17 children developed secondary glaucoma (secG; 11 eyes/8 patients), glaucoma suspect (suspG; three eyes/three patients) or ocular hypertension (OHT; 15 eyes/10 patients). No difference in surgrical procedure ( p = 0.62) was found, but age at cataract surgery differed significantly ( p = 0.048), with the secG group (1.74 ± 1.01 months) being the youngest (suspG: 3.93 ± 1.80 months; OHT group: 5.91 ± 5.36 months). Secondary surgical intervention was significantly higher in the secG (4.64 ± 3.41) followed by the suspG (2.00 ± 2.65) and OHT groups (0.40 ± 0.74; p < 0.001). Postoperative complications including nystagmus ( p = 0.81), strabismus ( p = 0.98) and amblyopia ( p = 0.73) showed no difference, in contrast to visual axis obscuration which was more common in the secG group ( p = 0.036). Conclusion: Initial lensectomy and anterior vitrectomy procedure together with or without IOL implantation seems to have no influence for the development of IOP changes after pediatric cataract surgery. However, children who developed secondary glaucoma had cataract surgery significantly earlier, within the first 2–3 months of life. Glaucoma surgery was required to achieve final IOP control in most eyes. The development of secondary glaucoma was also associated with a significant increase in surgical re-treatments.

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Epithelial downgrowth after Descemet membrane endothelial keratoplasty

European Journal of Ophthalmology ◽

10.1177/1120672120912413 ◽

2020 ◽

pp. 112067212091241

Author(s):

Viet Nhat Hung Le ◽

Florian Wabnig ◽

Bjoern Bachmann ◽

Claus Cursiefen

Keyword(s):

Anterior Segment ◽

Corneal Edema ◽

Endothelial Keratoplasty ◽

Descemet Membrane Endothelial Keratoplasty ◽

Visual Axis ◽

Corneal Incision ◽

Descemet Membrane ◽

Clear Corneal Incision ◽

Close Observation ◽

Histopathologic Evaluation

Purpose: To describe a patient with epithelial downgrowth after Descemet membrane endothelial keratoplasty. Methods: Case report. Results: A 73-year-old woman underwent triple Descemet stripping automated endothelial keratoplasty for cataract and corneal edema secondary to Fuchs endothelial dystrophy in the left eye elsewhere. Three years later, Descemet membrane endothelial keratoplasty was performed at our department due to graft failure. One month after the operation, her vision improved to 20/32 and maintained stable. At the 14-month visit, her visual acuity decreased, and a routine examination revealed epithelial downgrowth at the posterior surface of the cornea and partly beneath the graft, accompanied by presumed graft rejection. Therefore, repeat Descemet membrane endothelial keratoplasty with epithelial scraping and intracameral injection of 5-fluorouracil was indicated. She recovered 20/25 vision by 1 month after the surgery. However, small sheet-like epithelial downgrowth recurred 1 month later. The epithelial downgrowth was limited to the peripheral margin of the Descemet membrane endothelial keratoplasty graft and did not affect the visual axis. Epithelial downgrowth showed “islands” with connection between epithelial downgrowth and clear corneal incision on anterior segment optical coherence tomography images. Histopathologic evaluation of the removed Descemet membrane endothelial keratoplasty graft confirmed conjunctival epithelium as the source. Under close observation at the current 4-year follow-up, the epithelial downgrowth remained stable and localized and her vision increased to 20/20. Conclusion: Epithelial downgrowth can occur after Descemet membrane endothelial keratoplasty. The limited progression of epithelial downgrowth in this patient suggests that this condition after Descemet membrane endothelial keratoplasty even in the recurrence stage may cause less damage than expected and may only need to be observed closely if no progression occurs.

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