The "Polish Sign": A Novel Intraoperative Visual Indicator During Descemet Membrane Polishing in Cultured Human Corneal Endothelial Cell Injection Therapy.

To describe a case of Descemet's membrane detachment and schisis (Descemet's membrane separated into multiple layers) with confirmation by high-definition anterior segment optical coherence tomography (AS-OCT) after phacoemulsification and intraocular lens implantation. A 72-year-old woman presented with persistent corneal edema after phacoemulsification. She was diagnosed with herpes simplex keratitis and had been unsuccessfully treated for 60 days in her local hospital. Slit-lamp examination revealed moderate conjunctival injection, disciform-like stromal edema, and diffuse superficial punctate epithelial erosions. Descemet's membrane schisis and detachment with an interlayer tear were verified by high-definition AS-OCT. After 2 weeks of medication with topical 0.1% fluorometholone eye drops four times daily together with 3% ofloxacin eye ointment twice daily, Descemet's membrane was reattached with complete resolution of conjunctival injection, corneal edema, and epithelial erosions. This is a report of Descemet's membrane schisis in vivo that is documented and confirmed by high-definition AS-OCT. Descemet's membrane detachment and schisis caused by phacoemulsification can be misdiagnosed as herpetic keratitis due to stromal edema and epithelial erosion. Topical steroid and lubrication may help reattach Descemet's membrane to its original position.

Objective To discuss the causes and therapeutic measures for Descemet's membrane detachment after intraocular operation. Methods A retrospective analysis of 15 eyes of 15 cases of postoperative Descemet's membrane detachment who had undergone phacoemulsification (11 eyes), extracapsular cataract extraction (1 eye), trabeculectomy (2 eyes) and removal of silicone oil(1 eye). The diagnosis of Descemet's membrane detachment were confirmed by anterior segment OCT, included 10 mild cases(10 eyes), 2 moderate cases (2 eyes)and 3 severe cases(3 eyes). Twelve patients of mild and moderate detachment underwent anterior chamber gas tamponade 3 days after operation (1 case with 20% C3F8). In 3 cases of severe detachment, anterior chamber gas tamponade was performed in 1 case two months after surgery, Descemet's stripping automated endothelial keratoplasty (DSAEK) was performed in 1 case 3months after the surgery, and one case abandoned further treatment. Results In 12 cases of mild and moderate Descemet's membrane detachment reseted in 10 cases within 3 days, and it reseted in 2 cases after a second time of gas injection. In 3 cases of severe detachment, 1 case got descemet membrane reset and cornea transparent partly one day after gas injection. Corneal graft attached to graft bed in 1 case. The case abandoning treatment developed bullous keratopathy. Conclusion Anterior segment OCT is an effective examining method for the diagnosis of Decemet's membrane detachment. The key to Descemet's membrane reattachment is to implement anterior chamber gas injection and thoroughly remove the interlaminar effusion. DSAEK is an effective treatment method. Key words: Endothelium, corneal; Transplantation; Descemet's membrane detachment; Optical Coherence Tomography, anterior segment, ocular; Anterior chamber gas tamponade

To describe the clinical characteristics and treatment of spontaneous Descemet membrane (DM) detachment occurring decades after penetrating keratoplasty (PK). A multicenter interventional case series design was used. We reviewed the medical records of 4 patients with a history of PK presenting with spontaneous DM detachment at 3 university hospitals in Israel and an ocular surgery institute in The Netherlands in 2016 to 2019. Patient demographic and clinical data, postoperative best corrected visual acuity, findings on preoperative and postoperative anterior segment optical coherence tomography (AS-OCT), and graft survival were recorded. Patients were aged 46 to 50 years. All had undergone PK for keratoconus 20 to 26 years previously. Patients presented within 18 to 180 days of onset of visual disturbance. Symptoms included sudden painless visual loss (2 patients), gradual visual loss and foreign body sensation (1 patients), and visual loss not otherwise specified (1 patient). Slit-lamp examination showed corneal edema, and AS-OCT showed DM detachment of variable extent. In 2 patients, the initial diagnosis was graft rejection and failure. Treatment consisted of anterior chamber injection of air (n = 3) or 20% SF6 (n = 1). In 3 patients, the DM reattached and the cornea regained its clarity. The fourth patient had persistent DM detachment that required repeated PK. Spontaneous DM detachment can mimic late graft failure in patients after PK. If diagnosed early, DM reattachment may be performed by air/gas injection, avoiding repeated keratoplasty. Eyes with presumed late penetrating graft rejection or failure should be examined by AS-OCT to exclude DM detachment.

In this article, the significance of anterior segment optical coherence tomography (AS-OCT) to aid the clinical diagnosis and treatment of Descemet membrane (DM) detachment after phacoemulsification combined with intraocular lens implantation was retrospectively analyzed using 26 patients (26 eyes). The location and scope of DM detachment, its causative factors and the percentage of each detachment type are considered for clinical treatments. Based on the location and scope, the detachment can be divided into three types: (1) simple, (2) symmetrical and (3) complete DM detachment. Simple detachment, confined to the area of surgical incision (detachment range <1/4 corneal area), occurred in 69.20 % of cases (18/26), in which the DM detachment in the anterior lip accounted for 42.30% (11/26) and in the posterior lip accounted for 26.90% (7/26). Symmetrical DM detachment, referring to detachment (1/4 cornea area < detached area <1/2 corneal area) that appeared symmetrically on the surgical incision and the opposite site, accounted for 19.20% (5/26). Complete DM detachment (>1/2 of the corneal area), accounted for 11.50% (3/26). Interestingly, our findings suggest that the DM detachment after phacoemulsification is closely related to the location (simple and symmetrical DM detachment) and the skillfulness (complete DM detachment) of the surgical incision. Therefore, appropriate classification of DM detachment by AS-OCT and wise selection of surgical location can better guide cataract surgery in the future.

Our study aims to investigate a simple repair algorithm for Descemet's membrane detachment (DMD) following phacoemulsification with Pentacam and anterior segment optical coherence tomography (AS-OCT). Twelve patients with DMD were included in this retrospective study. All cases had persistent corneal edema after phacoemulsification and no improved response to conservative treatment. The repair algorithm consisted of delineating the DMD with the Pentacam and AS-OCT, paracentesis, and intracameral air bubble performed at the slit lamp, followed by immediate supine position. At one month, the final status of Descemet's membrane (DM), best-corrected visual acuity, and incidence of complications were noted. DMD was involved in the visual axis in all cases. The mean interval between phacoemulsification and repair was 5.3 ± 1.2 days. Complete reattachment of DM and corneal clarity occurred in all 12 eyes. Eleven (91.7%) eyes underwent one repair procedure, while one eye (8.3%) underwent a repeat procedure. No adverse events were found. Minor post-intervention complications included temporary increased intraocular pressure due to pupillary block in one eye (8.3%). In conclusion, our modified and simplified repair algorithm for DMD can be performed safely as an outpatient procedure, with accurate delineation using a Pentacam and AS-OCT. It may provide new insight into the timely diagnosis, evaluation, and management of DMD.

To report 2 cases of spontaneous Descemet membrane (DM) detachment 20 years after penetrating keratoplasty for keratoconus. A retrospective chart review of 2 patients was performed. Two male patients-ages 59 and 50-presented 21 and 25 years, respectively, after uncomplicated penetrating keratoplasty for keratoconus, complaining of foreign body sensation. Best-corrected vision was 20/40 and 20/30, respectively. For both patients, slit-lamp examination revealed peripheral corneal thinning and steepening and temporal peripheral microcystic edema of the graft without any sign of rejection. Subsequent anterior segment optical coherence tomography demonstrated a DM detachment localized to the area of the corneal edema. One patient's DM failed to reattach after anterior chamber air injection and he then underwent successful Descemet stripping automated endothelial keratoplasty with resultant best-corrected vision of 20/20. The other patient failed mechanical incision at the graft-host interface with air injection for possible retrocorneal membrane and then successfully underwent a sequential cataract and Descemet stripping automated endothelial keratoplasty with visual acuity of 20/30. Spontaneous DM detachment more than 2 decades after uncomplicated penetrating keratoplasty for keratoconus is a previously unrecognized entity. Novel imaging modalities such as anterior segment optical coherence tomography should be used to identify this clinically difficult to detect etiology of microcystic corneal edema. The cause of DM detachment is unclear, but it may be because of mechanical forces from a retrocorneal membrane or from progressive keratoconus leading to peripheral host corneal steepening and thinning.

Aims: To evaluate anterior segment optical coherence tomography (AS-OCT) in the diagnosis and treatment of Descemet’s membrane detachment (DMD) with severe corneal edema. Methods: Nine eyes of 7 consecutive patients with suspected DMD with severe corneal edema due to different causes were imaged with the AS-OCT system. Configuration of Descemet’s membrane (DM) was delineated before and after treatment, and quantitative analysis was performed. An appropriate treatment was chosen based on the imaging findings. Results: DMD was demonstrated as being present in all eyes via AS-OCT. Different statuses of the DM including planar/nonplanar detachment, local/extensive detachment, and rupture was documented using AS-OCT images. Two eyes were treated with conservative therapy, 6 eyes with intracameral air/gas tamponade and 1 eye with penetrating keratoplasty. One of the air tamponade treatments failed and all the other treatments were successful. Conclusion: AS-OCT is a valuable tool in the diagnosis of DMD both in terms of selecting the appropriate treatment, and monitoring treatment outcomes when corneal edema is present.

Purpose:To present a case with the late-onset post-phacoemulsification Descemet’s membrane detachment that has been treated successfully.Methods:Case report.Results:A 68-year-old female patient presented with the complaint of decreased vision in her pseudophakic left eye after a 4-week silent post-phacoemulsification period. In the biomicroscopy, corneal oedema was seen to be prominent on the nasal incision side. Anterior segment optical coherence tomography objectively revealed the presence of Descemet’s membrane detachment. Treatment of descemetopexy was applied by injecting 0.3-mL perfluoropropane gas into the anterior chamber. No complication associated with descemetopexy was noticed during recovery. Total Descemet’s membrane detachment reattachment was achieved and perfluoropropane gas resorption from the anterior chamber was completed by the end of 1-month post-injection. The cornea was transparent and best corrected visual acuity increased to 20/20.Discussion:DMD is a rare complication following phacoemulsification and this patient had not any preoperative, intraoperative, or postoperative risk factors for DMD.It generally occurs in early-postoperative period and late-onset DMDs have been reported less frequently.The success rates with intracameral gas injections in similar cases have been reported to be 90% - 95%.Conclusion:To the best of our knowledge, this is one of the latest onset post-phacoemulsification Descemet’s membrane detachment cases in literature that has been treated successfully. The results of this case showed that descemetopexy is a safe and effective treatment method for late-onset post-phacoemulsification DMD.

The aim of this study was to explore types of Descemet membrane detachment (DMD) after ocular surface burns by anterior segment optical coherence tomography. This is a pilot, case series, observational study. Patients with DMD after ocular surface burns were enrolled. Ophthalmologic examinations were performed in all patients including slit-lamp photography and anterior segment optical coherence tomography. Three types of DMDs in 9 eyes of 9 patients with ocular surface burns were identified depending on the detachment components involved with the pre-Descemet layer (PDL). Type A was referred as a taut chord that the PDL and Descemet membrane (DM) detached simultaneously but were remained attached to each other, while type B was identified as a wavy line separated from the stroma by a dark slit that demonstrated the detachment of DM from the PDL and stroma. Type C was defined as the DM detached with or without PDL but they were separated from each other. We found that DM and PDL were detached simultaneously in most condition, with type A in 4 cases, type C in 5 cases, and type B in only 1 case. Our study demonstrated 3 types of DMDs after ocular surface burns and revealed that the limbal involvement and retrocorneal exudations may give clues to DMD in the corresponding areas. DMDs may be neglected for long in patients with extensive limbal involvement in early stages and also play an important role in unstable ocular surface condition until the late stages of conjunctivalization after ocular surface burns.

To describe the clinical significance of in vivo corneal findings in eyes with acute corneal hydrops. Medical records and anterior segment optical coherence tomography (ASOCT) images of 24 patients with keratoconus and unilateral acute corneal hydrops were reviewed. Clinical findings and position, integrity, and orientation of the Descemet membrane (DM) on ASOCT were noted. Size of the DM break, depth of the DM detachment, and corneal thickness were measured by ASOCT and correlated with the duration of corneal edema, assessed clinically. Outcomes of intracameral perfluoropropane (C(3)F(8)) gas in 13 eyes and histopathological findings after penetrating keratoplasty in 2 eyes were also correlated with serial ASOCT findings. Duration of corneal edema was 9.3 ± 4.4 weeks. On ASOCT, DM showed 3 patterns: detachment with break and rolled ends (n = 13), detachment with break and flat ends (n = 10), and detachment with no break (n = 1). Initial corneal thickness was 1.3 ± 0.25 mm, size of the DM break was 1.1 ± 0.8 mm, and depth of the DM detachment was 0.9 ± 0.6 mm. On multiple regression analysis, duration of corneal edema showed significant positive association with the depth of DM detachment (P = 0.0002) and size of DM break (P = 0.002) and negative association with intracameral C3F8 (P < 0.0001). Correlation of ASOCT with histopathological findings revealed 2 stages of resolution of hydrops: reattachment of DM and endothelial migration. Eyes with deeper DM detachments and larger DM breaks required more time for resolution of corneal edema despite intracameral C(3)F(8). This association needs to be validated by a prospective study.

Neonatal corneal opacity (NCO) is an ophthalmologic emergency that severely threatens visual development. Among its causes, obstetric trauma, particularly from forceps delivery, remains a significant, though decreasing, etiology. This trauma can cause a rupture in Descemet's membrane (DM), leading to acute corneal edema, high astigmatism, and a profound risk of irreversible amblyopia. This narrative review aims to synthesize the most recent scientific evidence (2020-2024) on the approach to NCO, focusing on the clinical, imaging, and management findings that differentiate traumatic DM ruptures from their main clinical mimics. Methods: A narrative review was conducted, searching PubMed, SciELO, and LILACS for publications from 2020 to 2024 using relevant descriptors. Results: The synthesized literature indicates that any unilateral corneal clouding in a newborn with a history of instrumented delivery mandates urgent investigation. The classic differential diagnosis is primary congenital glaucoma (PCG). Clinical examination reveals that forceps-induced tears are typically vertical or oblique, whereas Haab's striae (from PCG) are horizontal or circumferential. Tools like Anterior Segment Optical Coherence Tomography (AS-OCT) are essential for confirming the presence, location, and extent of the DM tear or detachment. Management is time-sensitive and ranges from conservative (topical hypertonics) to surgical (descemetopexy with air/gas) or, in refractory cases, keratoplasty (PKP or DSAEK). Conclusion: The approach to neonatal corneal opacity requires rapid etiological clarification. The ophthalmologist plays a central role in using clinical history and advanced imaging (AS-OCT) to distinguish traumatic from congenital causes, a distinction that dictates immediate management and the critical, long-term strategy for amblyopia prevention.

As patients with previous radial keratotomy (RK) are still occasionally encountered, recognition of the anatomy of post-RK corneas and management of their complications remain relevant. High-definition anterior segment optical coherence tomography (AS-OCT) is a very useful tool to assess these postsurgical corneas. To describe a case of acute corneal hydrops with Descemet membrane schisis after RK with observation by AS-OCT. A 43-year-old woman presented with a 9-day history of sudden vision loss, foreign body sensation, and photophobia in her left eye. She had undergone bilateral RK 25 years ago at her local hospital. Slit-lamp examination revealed marked corneal edema and stromal clefts in the central cornea along with radial surgical scars in her left eye. Pentacam imaging showed the typical pattern of a post-RK cornea with ectasia in her right eye. Multiple dilacerations of collagen lamellae and fluid-filled intrastromal cysts together with epithelial edema were observed in her left eye using AS-OCT. A Descemet membrane detachment with schisis was also shown by AS-OCT. After 5 months of medication with topical 0.1% fluorometholone eye drops four times daily together with 3% ofloxacin eye ointment once daily, the corneal edema, Descemet membrane detachment, and Descemet membrane schisis had completely resolved resulting in pan-stromal scarring. This report describes acute corneal hydrops with Descemet membrane schisis after RK imaged using high-definition AS-OCT. The acute hydrops was possibly caused by corneal ectasia or underlying keratoconus, which was aggravated by RK. High-definition AS-OCT is a useful tool to demonstrate the details of different corneal layers and to observe the resolving process of acute hydrops. Topical medications consisting of antibiotic, lubrication, and corticosteroid can be used to treat the acute event effectively.

Descemet’s membrane detachment (DMD) is an uncommon corneal pathology that typically occurs following intraocular surgeries or direct ocular trauma. Congenital or birth trauma-related DMD is rare and often remains undiagnosed in asymptomatic individuals. Longstanding cases may develop fibrous bridging or retrocorneal membrane formation, making diagnosis challenging without advanced imaging.We report the case of a 32-year-old asymptomatic male who presented for a routine ophthalmic evaluation. Slit-lamp examination of the right eye revealed a localized inferotemporal corneal opacity with subtle posterior corneal striae. The patient’s history was significant for a forceps-assisted birth complicated by right auricular deformity. Anterior segment optical coherence tomography (AS-OCT) demonstrated a planar DMD with fibrous bridging and retrocorneal membrane formation, sparing the visual axis. Best corrected visual acuity was 6/9 partial bilaterally, and intraocular pressures were normal. In the absence of symptoms or visual axis involvement, conservative management with regular follow-up was advised. At six months, the patient remained asymptomatic with stable findings.Birth trauma-related DMD is rarely detected in adulthood, especially in the absence of visual impairment. The combination of external markers of birth trauma such as auricular deformity and characteristic posterior corneal striae should prompt consideration of this diagnosis. AS-OCT plays a crucial role in confirming and characterizing chronic DMD, particularly when slit-lamp findings are subtle. Previous studies have highlighted that these lesions may remain stable for years but can occasionally result in visually significant astigmatism or corneal decompensation, necessitating intervention.To the best of our knowledge, this is the first report demonstrating fibrous bridging associated with birth trauma-related DMD using AS-OCT. This case underscores the importance of obtaining a thorough birth history and utilizing AS-OCT to evaluate unexplained posterior corneal changes. Conservative management is appropriate in asymptomatic cases without central corneal involvement, but long-term follow-up is essential to detect potential progression.

Management of Descemet membrane detachment secondary to forceps assisted delivery in a newborn

Manejo de la rotura de la membrana de Descemet secundaria a traumatismo por fórceps durante el parto