Descemet's Membrane Detachment Research Articles

Complications after Gonioscopy-Assisted Transluminal Trabeculotomy in glaucoma treatment - literature review.

Glaucoma is a disease that leads to optic nerve damage and irreversible loss of the visual field. Gonioscopy-assisted transluminal trabeculotomy (GATT) is a minimally invasive glaucoma surgery technique, where the surgeon opens the trabecular network and Schlemm's canal to improve the outflow of the aqueous humor. This method has shown efficacy in reducing intraocular pressure in patients with primary and secondary glaucoma. GATT has gained popularity due to its minimally invasive nature, compatibility with cataract surgery and relatively low cost. Despite its advantages, the procedure can be associated with many complications such as hyphema, intraocular pressure spikes and corneal edema. In rare cases, it can lead to Descemet's membrane detachment or cystoid macular edema. The success of GATT procedure mostly depends on the surgeon's skill and experience, but also on the patient's risk factors, including age and preoperative intraocular pressure levels. Further studies are required to understand long outcomes and identify the patients, who may be at higher risk of complications.

Long-term efficacy and safety of ab externo canaloplasty in the Polish Caucasian population with open-angle glaucoma: A 3-year retrospective study.

This study aimed to assess the effectiveness and safety of ab externo canaloplasty over a 3-year follow-up period in Polish Caucasian patients with glaucoma. This retrospective study of a cases series was conducted at the Department of Ophthalmology Medical University of Bialystok, Poland. Primary outcome measures were intraocular pressure and medication burden. Secondary outcome measures were best corrected visual acuity, retinal nerve fiber layer thickness, visual field test results, endothelial cell density, intraoperative and postoperative complications, and additional glaucoma surgery. The study group consisted of 160 eyes diagnosed with early to-moderate primary open-angle glaucoma and treated with ab externo canaloplasty from 2014 to 2020. The criteria for qualified and complete success were intraocular pressure < 18 mmHg or ≥ 20% reduction in intraocular pressure from baseline with or without antiglaucoma medications, respectively. After surgery, the mean intraocular pressure decreased from 19.23 ± 4.33 to 14.52 ± 3.79 mmHg, which constituted a 36.7 ± 7.8% reduction compared to the baseline value. The number of medications decreased by two at the end of the study period (from 2.69 ± 1.05 to 0.32 ± 0.75). Complete and qualified success were achieved in 58.7% and 68.7% of the patients, respectively, at the end of follow-up. An incomplete cannulation of Schlemm's canal was the most common intraoperative complication, occurring in 32 eyes (20%). The most frequent postoperative complications were hyphema, Descemet's membrane detachment, and a transient increase in intraocular pressure. Additional surgical procedure was required in seven cases (4.4%). In 16 patients (10%), medical treatment was re-administered. Overall, our findings suggest that ab externo canaloplasty is a good option for Polish Caucasian patients with primary open-angle glaucoma. It reduces intraocular pressure and has a low postoperative complication rate. Additional glaucoma surgery or re-administration of medications is required if the target intraocular pressure is unsatisfactory.

Incidence of Descemet Membrane Detachment after Phacoemulsification Cataract Surgery in a Sample of Iraqi Patients at Ibn Al-Haitham Teaching Eye Hospital

Incidence of Descemet Membrane Detachment after Phacoemulsification Cataract Surgery in a Sample of Iraqi Patients at Ibn Al-Haitham Teaching Eye Hospital

Delayed-onset spontaneous bilateral Descemet’s membrane detachment after uneventful phacoemulsification

A 69-year-old male presented with defective vision in both eyes. Best corrected visual acuity (BCVA) was 6/6 p with anterior cortical and posterior subcapsular cataracts in both eyes. Fundus examination was normal. He underwent successful phacoemulsification with intraocular lens implantation in the left eye, improving BCVA to 6/6. Two months later, BCVA in the right eye decreased to 6/12p; cataract progression was noted. Phacoemulsification in the right eye restored BCVA to 6/6. Four months post-left eye surgery, he developed corneal edema with descemet membrane detachment (DMD). Multiple descemetopexies with SF6 led to reattachment. Right eye also developed DMD which reattached with SF6 descemetopexy. Final visual acuity was 6/6 in the right eye and 6/6 partial in the left eye.

Obstetrical forceps induced Descemet’s membrane detachment (DMD)

Obstetrical forceps induced Descemet’s membrane detachment (DMD)

Modelling gravity-driven aqueous humour flow and drug delivery in Descemet’s membrane detachment

Topical medications are common initial treatments for Descemet’s membrane detachment (DMD). It is crucial to understand the aqueous humour (AH) flow and drug transport to facilitate the DMD treatment. This paper presents a mathematical model to analyse AH flow and drug transport in the anterior of the human eye considering gravity orientation effects. Utilizing the finite element method, the model couples AH flow dynamics, temperature-induced buoyancy, and drug transport by convection-diffusion. COMSOL Multiphysics is used to simulate the spatial-temporal distribution of AH and drugs delivery. The findings indicate that the eye positioning influences the directional flow of AH, due to temperature differences, and impacts the delivery of drug concentrations. It is also discovered that eye drops diffuse faster due to tear turnover in the eye yet more eye ointment is delivered as it has a longer contact time in the cornea. By understanding the AH flow and transport process, this proposed model may offer appropriate guidelines for optimizing DMD treatment under various forms of topical drugs and eye positions.

Bilateral spontaneous Descemet membrane detachment after uneventful immediate sequential bilateral cataract surgery

Introduction: Immediate sequential bilateral cataract surgery (ISBCS) is a practice on the rise. To the authors' knowledge, this is the first reported case of bilateral Descemet membrane detachment (DMD) after uneventful same-day ISBCS, with emphasis on diagnosis and management. Patient and Clinical Findings: The case of a 66-year-old diabetic woman with chronic obstructive pulmonary disease and obstructive sleep apnea on home oxygen who developed spontaneous bilateral DMD after uneventful ISBCS for visually significant cataracts is presented. Although spontaneous DMD after uneventful phacoemulsification has been reported before, it has not been reported after same-day ISBCS to the authors' knowledge. The success rates with air pneumatic descemetopexy are excellent, with ranges between 90% and 95%. In this case, surgical intervention with gas injection in the anterior chamber and surgical peripheral iridotomies resulted in excellent visual acuity restoration in the patient. Diagnosis, Intervention, and Outcomes: Patient underwent same-day ISBCS under local anesthesia by different surgeons in either eye. Standard phacoemulsification techniques were used, and no intraoperative complications were noted. The patient returned with bilateral counting fingers vision 4 weeks postoperatively and reported her vision never improved after her cataract extraction. Anterior segment optical coherence tomography (AS-OCT) confirmed the presence of bilateral DMDs. Because of the patient's severely impaired vision, bilateral air descemetopexies were performed with clinical resolution of the DMD and excellent restoration of vision in both eyes. Conclusions: Sufficient evidence supports that performing ISBCS using internationally agreed protocols minimizes the risk of experiencing bilateral complications to a negligible level when compared with staged surgery. However, with ISBCS being on the rise, spontaneous bilateral DMDs may also be seen increasingly in those eyes with no underlying commonly recognized risk factors for spontaneous DMD. With unilateral DMD, watch and wait is a viable option. However, in bilateral DMD cases, earlier air or gas descemetopexy may be preferable to increase the likelihood of success and reduce the patient's period of decreased vision.

A technique to treat Descemet's membrane detachment following cataract surgery.

We describe a technique to reattach the detached Descemet's membrane, following cataract surgery. From the main clear corneal cataract incision, aqueous humor is ejected completely by apposition of the cornea to the iris for approximately 3 s. This ensures the fluid in the space between the stroma and Descemet's membrane is ejected and the detached Descemet's membrane returns to its original position. Sterile air is injected through a paracentesis 180 degrees away from the Descemet's membrane detachment, to maintain a complete air-filled chamber. Full air tamponade is maintained for 20 min, following which one-third of the air is ejected from the chamber to prevent an increase of postoperative intraocular pressure.

Intraoperative partial thickness compression suturing for descemet’s membrane detachment: A Novel technique

: To evaluate the efficacy of partial thickness transcorneal compression suturing with air desmetopexy in descemet’s membrane detachment (DMD) during cataract surgery: This is a retrospective review of records of patients who were managed for non-planar DMDs during phacoemulsification or small incision cataract surgery with partial thickness suturing with air descemetopexy in virgin eyes. : A total of fifteen cases were identified including 11 females and 4 males with average age of 67 years. All patients involved in the study underwent uneventful cataract surgery. All 15 cases involved in the study with DMD during cataract surgery were caused by intra-operative trauma during different instrumentations. Five cases had peripheral DMDs and ten cases had central DMDs. The average size of non-planar DMD was 4 mm. Ten cases had DMDs with scrolled margins. Eight patients achieved the best corrected visual acuity (BCVA) of 6/6 at the end of one month with clear corneas. Descemet’s membrane (DM) got completely attached at two weeks follow-up. The suture removal was done approximately after one month of follow-up. : Partial thickness transcorneal compression suturing with air desmetopexy in non-planar DMD is very helpful in recovering traumatic corneal edema during cataract surgery.

Outcome of Descemet membrane detachment repair using air descemetopexy and Descemet membrane suturing after cataract surgery

Outcome of Descemet membrane detachment repair using air descemetopexy and Descemet membrane suturing after cataract surgery

Relaxing descemetotomy: microscope-integrated OCT-guided technique for acute corneal hydrops.

3 cases are used to illustrate the technique of Descemet membrane (DM) relaxing incisions followed by air descemetopexy for the management of patients with acute corneal hydrops. In each case, anterior-segment optical coherence tomography (OCT) demonstrated taut DM detachments and hydrops was refractory to conservative medical management and intracameral air injection. To facilitate the reapproximation of DM and potentiate corneal deturgescence, intraoperative OCT-guided descemetotomy was performed with bent surgical scissors and a bent 30-gauge needle. Subsequent air descemetopexy was successful, and DM reattachment was maintained postoperatively. Corneal edema improved in all patients relatively rapidly postoperatively. Relaxing descemetotomy with air descemetopexy may be useful in cases of acute corneal hydrops with taut DM detachments that are unresponsive to air tamponade alone.

Intraoperative corneal staining during cataract surgery

Intraoperative corneal staining with trypan blue dye is an uncommon complication of cataract surgery that occurs at the time of staining of the anterior capsule. Inadvertent corneal staining with Descemet’s membrane detachment (DMD) occurred in a 70-year-old male, while stromal edema following corneal staining occurred in an 80-year-old female while attempting to stain the anterior capsule. DMD was managed with air tamponade, and stromal edema was conservatively managed. One must thus be aware of corneal staining with trypan blue during cataract surgery. This complication can be avoided by using sharp-tipped instruments, proper wound construction, and proper depth perception, which can be done by adjusting the microscope.

Incidence and Clinical Features of Immunologic Rejection After Deep Anterior Lamellar Keratoplasty.

The aim of this study was to investigate the incidence and clinical features of immunologic rejection after deep anterior lamellar keratoplasty (DALK). This study included 411 patients (464 eyes, median age [interquartile range; IQR] 55.8 years [36.1-69.5]) who underwent DALK at Tokyo Dental College between June 1997 and 2021. Of 411 patients, 24 (24 eyes [5.2%], 51.9 years [IQR 31.6-65.4]) developed immunologic rejection. We characterized the clinical features, risk factors associated with immunologic rejection, and prognosis. The interval between DALK and immunologic rejection was 14.5 (range, 5-78) months. Immunologic rejection occurred after cessation/reduction of topical steroid in 9 (47.4%) and suture removal in 4 eyes (21.1%). The postoperative duration of topical steroid use in eyes with immunologic rejection was significantly shorter (10.0 months, [IQR 6.0-14.0]) than those without immunologic rejection (28.3 [IQR 15.8-42.7], P = 0.001). Immunologic rejection manifested as stromal edema in 19 (100.0%), ciliary hyperemia in 17 (89.5%), keratic precipitates in 13 (68.4%), epithelial edema in 13 (68.4%), infiltration in 9 (47.4%), corneal opacity in 4 (21.1%), and Descemet membrane detachment in 2 eyes (10.5%). After treatment, corneal clarity was restored in 17 eyes (89.5%); however, immunologic rejection led to corneal endothelial decompensation in 2 eyes (10.5%). Endothelial cell density decreased from 1795.7 ± 722.6 to 1651.6 ± 655.6 cells/mm 2 after immunologic rejection ( P = 0.074). Post-DALK immunologic rejection was associated with specific clinical triggers such as reduction/cessation of topical steroids or suture removal.

The pre-Descemet's layer (Dua's layer, also known as the Dua-Fine layer and the pre-posterior limiting lamina layer): Discovery, characterisation, clinical and surgical applications, and the controversy.

The pre-Descemet's layer/Dua's layer, also termed the Dua-Fine layer and the pre-posterior limiting lamina layer, lies anterior to the Descemet's membrane in the cornea, is 10 μm (range 6-16) thick, made predominantly of type I and some type VI collagen with abundant elastin, more than any other layer of the cornea. It has high tensile strength (bursting pressure up to 700mm of Hg), is impervious to air and almost acellular. At the periphery it demonstrates fenestrations and ramifies to become the core of the trabecular meshwork, with implications for intraocular pressure and glaucoma. It has been demonstrated in some species of animals. The layer has assumed considerable importance in anterior and posterior lamellar corneal transplant surgery by improving our understanding of the behaviour of corneal tissue during these procedures, improved techniques and made the surgery safer with better outcomes. It has led to the innovation of new surgical procedures namely, pre-Descemet's endothelial keratoplasty, suture management of acute hydrops, DALK-triple and Fogla's mini DALK. The discovery and knowledge of the layer has introduced paradigm shifts in our age old concepts of Descemet's membrane detachment, acute corneal hydrops in keratoconus and Descemetoceles, with impact on management approaches. It has been shown to contribute to the pathology and clinical signs observed in corneal infections and some corneal dystrophies. Early evidence suggests that it may have a role in the pathogenesis of keratoconus in relation to its elastin content. Its contribution to corneal biomechanics and glaucoma are subjects of current investigations.

Novel trocar assisted intraocular lens and capsular bag complex fixation.

To describe the innovative technique of trocar-assisted intraocular lens (IOL) and capsular bag complex fixation. In this technique, initial pupil dilatation is achieved either with intracameral adrenaline or with the help of iris hooks. Automated anterior vitrectomy is performed in cases with vitreous prolapse. A 25 G trocar cannula is placed at the limbus through a paracentesis opposite the zonular dialysis area. The cannula lumen act as a guide to pass the double-arm polypropylene suture attached to the needle. This prevents any inadvertent corneal injury and acts as a perpendicular tract to pass the needle through IOL capsular bag complex. We performed this technique in 9 cases with an excellent outcome with a minimum of 3 months of follow-up. All patients had well-centred IOL. There was no incidence of corneal injury, Descemet membrane detachment, iris trauma, IOL tilt, decentration, dislocation, vitreous prolapse or retinal detachment. All patients achieved excellent visual acuity ranging from 6/12-6/6 postoperatively. The novel trocar-assisted IOL bag complex fixation technique is very effective and allows smooth IOL fixation in technically challenging cases with IOL subluxation. The trocar acts as a guide to prevent injury to the surrounding tissue, and IOL fixation is achieved with minimal manipulations in the anterior chamber. It also prevents the need for IOL explantation in these cases.

An unusual case of late spontaneous reattachment of Descemet membrane detachment after deep anterior lamellar keratoplasty: A case report

Deep anterior lamellar keratoplasty (DALK) is a feasible option in children with advanced keratoconus with or without stromal scarring. Descemet membrane detachment (DMD) and formation of double anterior chamber is one of the rare but serious complication of DALK surgery. Various treatment methods like descemetopexy with air, perfluoropropane gas (C3F8), and SF6 (sulfur hexafluoride gas) can be tried. We report a case of spontaneous reattachment of DMD in a pediatric male patient with Descemet membrane microperforation during DALK.

Spontaneous Descemet membrane detachment in an elderly patient after uneventful cataract surgery

Spontaneous Descemet membrane detachment in an elderly patient after uneventful cataract surgery

Descemetopexy: A Little More Than Just Providing Support!! A Gist on Descemet Membrane Detachment and Descemetopexy Procedure

Descemet membrane detachment can be seen after any intraocular procedure but is more common after cataracts and cornealsurgeries, especially in the hands of novice surgeons early in their training period. Prompt recognition and appropriatemanagement can prevent the decompensation of cornea timely. Descemetopexy is a popular method to reduce cornel edemaand improve patient prognosis. This article gives an insight into the procedure as well as the identification and managementof a descemet membrane detachment.

Persistent Localized Descemet Membrane Endothelial Keratoplasty Detachments Secondary to Corneal Ink Stain Marks.

The aim of this study was to describe 2 cases of persistent endothelial graft detachments secondary to corneal gentian violet ink stain marks. This study included a case review of hospital records of 2 eyes with localized Descemet's membrane detachments after Descemet membrane endothelial keratoplasty (DMEK) surgery. Two patients underwent consecutive uncomplicated DMEK surgery for Fuchs endothelial dystrophy with identical techniques. The grafts were marked with an ink marker through a stromal window to ensure correct orientation during donor graft preparation. Both patients had localized detachments around the ink mark on day 1, week 1, and up to 1 month at postoperative review. The persistent detachment was believed to be due to the gentian violet marker used which had a higher concentration of isopropyl alcohol solvent than the standard marking pen routinely used. Ink markers with higher concentrations of isopropyl solvent may result in higher DMEK detachment rates and caution is advised when using these markers.

Surgical management of complicated Descemet’s membrane detachment in corneas without prior endothelial keratoplasty

PurposeTo provide insights into morphologic and functional features of eyes with complicated Descemet's membrane detachment (DMD) and report clinical outcomes after surgical intervention.MethodsRetrospective study of 18 eyes with complicated DMD between 2010 and 2022. Complicated DMD was defined if any of the following criteria applied: prior penetrating keratoplasty (PKP), corneal thinning, total DMD or persistent DMD after Air/Gas-Descemetopexy. Causes, surgical management, and clinical outcomes were analyzed. Scheimpflug tomography, anterior segment optical coherence tomography (AS-OCT) and histologic examination were performed to characterize corneas with DMD.ResultsFourteen eyes with prior PKP developed spontaneous DMD after 24.2 ± 12.9 years (range = 18 months – 47 years, median = 25.7 years). Complicated DMD without prior PKP was associated in three eyes after cataract surgery and in one eye after infectious keratitis. In cases with previous PKP, AS-OCT demonstrated rupture of Descemet’s membrane (DM) in five eyes and spontaneous reattachment was found in four eyes within 8 weeks of initial diagnosis, with no rupture of DM in any of the cases. There was no rupture of DM in corneas without previous PKP. After prior keratoplasty, definitive surgical treatment was repeat PKP in 13 eyes and Air/Gas-Descemetopexy in one eye. In corneas without prior keratoplasty, three eyes underwent PKP and one eye Air/Gas-Descemetopexy. Histological examination of two corneal explants revealed a severely thinned graft-host junction and a disrupted DM close to the graft-host junction. Visual acuity improved from 1.80 ± 0.58 logMAR to 0.75 ± 0.69 logMAR after prior PKP and from 1.45 ± 0.65 logMAR to 0.85 ± 1.13 logMAR without prior PKP. The postoperative course was uneventful in 16 of 18 eyes.ConclusionPKP is an effective treatment option for complicated DMD, especially in ectatic corneas, whereas Air/Gas-Descemetopexy or Descemet Membrane Endothelial Keratoplasty do not address the primary issue of the curvature anomaly.