Descemet’s Membrane Injury Post YAG Peripheral Iridotomy

Abstract

Neodymium: Yittrium - Aluminium-Garnet (Nd YAG) laser iridotomy is one of the most common laser procedures performed in the Asian continent as the proportion of Angle closure glaucoma cases is significant. The Nd YAG iridotomy appears to be a simple outpatient procedure but can result in a number of complications including haemorrhage, cataract formation, dysphotopsia, intraocular pressure elevation and corneal endothelial damage resulting in corneal decompensation at a later date. A forty one year old female patient, a case of Primary Angle Closure Suspect (PACS), who had undergone a Nd YAG laser iridotomy of both the eyes elsewhere presented to us for a second opinion. The anterior segment examination was unremarkable except for the bilateral peripheral Iridotomies. The slit lamp examination revealed three small defects in the temporal cornea at the level of the Descemet’s membrane and posterior stroma overlying the iridotomy in the right eye. A specular microscopy did not reveal any endothelial damage or change in the cell morphology overlying the iridotomy or in other areas. Anterior segment Ocular Coherence Tomography (OCT) demonstrated the exact nature of the injury to the Decemets membrane. To the best of our knowledge, its the first case report in the literature of a Descmet’s membrane injury following a ND-YAG laser iridotomy. It emphasizes the importance of accurate focus on the iris and choosing a quadrant with adequate distance between the iris and the cornea to avoid injury to surrounding structures.