Abstract
A 75-year-old man with underlying left eye idiopathic orbital inflammatory disease and bilateral glaucoma suspect with cup disc ratio 0.7 underwent right eye phacoemulsification. Intraoperatively, Descemet tear and Descemet membrane detachment (DMD) occurred. Pneumodescemetopexy with air bubble was performed. His vision remained counting fingers and the cornea was oedematous three weeks after the operation. Anterior segment optical coherence tomography (ASOCT) showed extensive (80%) rhegmatogenous DMD with planar edge and a maximum of 460 micrometers separation from the stroma. Pneumodescemetopexy with low concentration perfluoropropane (10% C3F8) was performed together with postoperative positioning. On day five post-pneumodescemetopexy, his vision improved to 6/9, the cornea cleared with mild Descemet striae, and the gas bubble reduced to 30% fill. There was no DMD detected on ASOCT. His vision remained 6/9 and the residual gas bubble was 15% in the anterior chamber at two weeks post-pneumodescemetopexy. This case report suggests that pneumodescemetopexy with 10% C3F8 successfully reattached the large nonplanar rhegmatogenous DMD.
Highlights
Descemet membrane is the basement membrane of corneal endothelium and helps to maintain corneal transparency together with endothelium
On day five post-pneumodescemetopexy, his vision improved to 6/9, the cornea cleared with mild Descemet striae, and the gas bubble reduced to 30% fill
We report a case of nonplanar rhegmatogenous large Descemet membrane detachment (DMD) treated with pneumodescemetopexy by using a lower concentration of 10% C3F8
Summary
Descemet membrane is the basement membrane of corneal endothelium and helps to maintain corneal transparency together with endothelium. Injection of 10% C3F8 gas into the anterior chamber using a 27G needle at eight o’clock via the clear cornea near the limbus was performed under topical anesthesia This location was chosen as here the Descemet membrane was still well attached to the stroma. Less than 10% of the Descemet membrane remained mildly detached, mainly at the inferonasal part of the cornea His intraocular pressure (IOP) at one hour and two hours post-operation were normal at 13-15 mmHg. His intraocular pressure (IOP) at one hour and two hours post-operation were normal at 13-15 mmHg He was advised to maintain a right cheek to pillow position, and to avoid going to locations of high elevation. There was no DMD detected on ASOCT His vision remained at 6/9 and the residual gas bubble was 20% in the anterior chamber at two weeks post-pneumodescemetopexy (Figure 2). The vision of the patient was 6/6 and the cornea was clear with no DMD at three months follow-up (Figure 3)
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