Descemet's Membrane Detachment Research Articles

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/mm2 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.

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.

Diagnosis and treatment of traumatic Descemet's membrane detachment: A case series.

The Descemet layer is a dense layer of tissue that does not detach under normal circumstances. Descemet layer detachment may occur after intraocular surgery, but the Descemet layer spontaneously detached after trauma in this child, which is relatively rare. After looking for the cause, we found that the child was diagnosed with congenital glaucoma, and the trauma induced the Descemet's membrane detachment. The parents of the patient expected the child to recover the normal shape of the cornea as soon as possible, improve vision, and solve the problem of congenital glaucoma. The patient was diagnosed with Descemet's membrane detachment of the left eye and congenital glaucoma in both eyes. During operation, inflation gas is injected into the anterior chamber, the Descemet's membrane is reset, and glaucoma surgery is performed. The Descemet's membrane in the child's eye was reset, and after glaucoma surgery, the intraocular pressure of the child was normal. The analysis of the disease is not only to solve the problems seen but also to deeply analyze the internal causes and pathological changes in combination with the symptoms and signs, so as to discover the essence of the problem and solve the fundamental problem of the patient.

Early detection and descemetopexy boon for visual outcome in Descemet’s membrane detachment following cataract surgery

To compare results of early intra-operative versus post-operative Descemet’s membrane detachment (DMD) detection and descemetopexy.Data was collected retrospectively for patients who developed DMD from December 2018 to March 2020 and underwent air descemetopexy.: The study comprised of 85 eyes of 85 patients. (which 4 were excluded.) There were 41 males and 39 females. Mean age was 66.93 years (SD ± 12.21). 4 eyes had mild DMD which were excluded from final analysis. 55 eyes had moderate & 26 had severe DMD. 68 eyes had intraoperative descemetopexy (Group 1) and 13 had late detection of DMD with late post-operative descemetopexy (Group 2). Median final BCVA in group 1 was 0.17 logMAR(IQR 0.13) & in group 2 was 0.60 logMAR(IQR 0.22).Air descemetopexy gives acceptable results in cases of DMD. However early detection of DM detachment during primary surgery with early descemetopexy yields better results in visual outcome of patients. Hence, carefulness in detection of intra-operative complications should be kept and early descemetopexy should be considered to prevent severe visual loss due to DMD.

Comparing morphologic features and complications of main clear corneal incision between junior and senior residents observed using anterior segment optical coherence tomography.

Wound construction is a critical step in phacoemulsification. Using anterior segment optical coherence tomography (AS-OCT), we compared the morphological features and complications of main incisions made by junior or senior residents during phacoemulsification. This cross-sectional comparative study included eyes with senile cataracts that underwent uneventful phacoemulsification with a clear corneal incision made by seven senior and eight junior ophthalmology residents. All eyes underwent postoperative image acquisition using AS-OCT on day one and at three months, examining for morphological features and potential complications of the main incision. We included 50 eyes of 50 patients with a male-to-female ratio of 22 (44%) to 28 (56%); 26 (52%) were operated on by junior residents and 24 (48%) by seniors. The mean geometric features of the main incisions and the frequency of early and late wound complications were comparable between the two groups (all P > 0.05). A significant correlation was found between the incision length and angle with the superior (r = + 0.80; P < 0.001 and r = - 0.63; P < 0.001, respectively) and inferior (r = + 0.84; P < 0.001 and r = - 0.68; P < 0.001, respectively) areas of the incision, as well as between the length and angle of incision (r = - 0.74; P < 0.001). The number of planes in the wound architecture was not significantly different according to senior or junior resident status (P > 0.05). Although the number of eyes with stromal hydration was significantly greater for junior residents than for seniors (P < 0.001), the corneal thickness at the entrance to the cornea or the anterior chamber, presence of endothelial wound gaping, and Descemet's membrane detachment were comparable between eyes with and without stromal hydration (all P > 0.05). At three months, 29 (58%) patients returned for examination, in whom seven (24%) had late wound complications. This study found no significant differences in the performances of junior and senior residents in terms of wound construction or its associated complications. However, considering the overall rate of some observed wound-related complications, we recommended revision of the resident educational curriculum concerning the structure and complications of the main incision.

Long-Term Clinical and Safety Outcomes of Canaloplasty Performed across All Grades of Glaucoma Severity.

To investigate the clinical effectiveness of canaloplasty performed with an ab interno technique using the iTrack microcatheter (Nova Eye Medical) in patients with mild-moderate glaucoma as compared to severe glaucoma. This is a retrospective single-center case series. Patients were preoperatively categorized as mild/moderate vs. severe glaucoma assessed using the mean deviation (MD) score and controlled group (baseline intraocular pressure (IOP) ≤18 mmHg) vs. uncontrolled group (>18 mmHg). All patients with glaucoma were eligible for recruitment except those who had undergone previous glaucoma surgery (with the exception of selective laser trabeculoplasty or SLT). Patients underwent canaloplasty via an ab interno surgical technique with or without phacoemulsification and were monitored for IOP, glaucoma medication usage, and surgical complications. In total, 72 eyes were followed for 3.4 ± 0.5 years. Mean pre-op IOP (mmHg) was 19.3 ± 7.7 in the standalone group (n = 9) and 18.5 ± 5.6 in the combined group (n = 63) (p=0.38). At the last follow-up, mean IOP reduced by 36% to 12.4 ± 4.4 (p=0.02) in the standalone group and by 26% to 13.7 ± 4.8 in the combined group (p < 0.001). Mean pre-op IOP (mmHg) was 18.6 ± 5.2 in the severe group (n = 24) and 18.6 ± 6.2 in the mild-moderate group (n = 48) (p=0.48). Mean IOP was 14.1 ± 6.3 (-24%; p < 0.001) and 13.3 ± 3.7 (-29%; p < 0.001), respectively, at the last follow-up. Mean glaucoma medication usage decreased from 2.5 ± 0.9 to 2.1 ± 0.9 (-15%; p=0.083) in the severe group and 2.3 ± 1.0 to 1.4 ± 1.3 (-40%; p < 0.001) in the mild/moderate group. There was one localized Descemet's membrane detachment in the moderate group. iTrack canaloplasty achieved a statistically significant IOP reduction in mild-moderate and severe eyes and was found to be an effective option for reducing IOP and medications in patients with mild-moderate primary open-angle glaucoma (POAG). In severe eyes, it has reduced IOP while the medications remained stable.

Double bubble pneumo-descemetopexy for the management of Descemet membrane detachment: An innovative technique.

A 62-year-old woman was referred with poor vision following manual small incision cataract surgery. On presentation, the uncorrected distance visual acuity in the involved eye was 3/60, whereas slit-lamp examination revealed a central corneal edema with the peripheral cornea relatively clear. Direct focal examination with a narrow slit upper border and lower margin of detached rolled up Descemet's membrane (DM) could be visualized. We performed a novel surgical approach, "double-bubble pneumo-descemetopexy." The surgical procedure included unrolling of DM with "small air bubble" and descemetopexy with "big bubble." No postoperative complications were observed, and best corrected distance visual acuity improved to 6/9 at 6 weeks. The patient had a clear cornea and maintained BCVA 6/9 during 18 months at follow-up. Double-bubble pneumo-descemetopexy, a more controlled technique, provides a satisfactory anatomical and visual outcome in DMD without the need for endothelial keratoplasty (Descemet's stripping endothelial keratoplasty or DMEK) or penetrating keratoplasty.

Outcomes of manual small incision cataract surgery (MSICS) in eyes with corneal opacity.

To report the outcomes of manual small incision cataract surgery (MSICS) in eyes with corneal opacity. Tertiary care ophthalmic hospital. Retrospective study. This retrospective study included 286 eyes of 286 patients having cataract with a pre-existing corneal opacity who underwent manual small incision cataract surgery (MSICS) at a tertiary eye institute between January 2020 and January 2022. Data were retrieved from electronic medical records, and we documented demographics, history, detailed anterior and posterior segment examination, cataract grading, pre- and post-operative vision, intra-operative complications and its management, and post-operative course. All these parameters were recorded at the baseline visit, day 1 and at 1month post-operatively. Two hundred eighty-six eyes having cataract with a pre-existing corneal opacity which underwent MSICS were evaluated. Corneal opacity was graded as nebular, nebulo-macular, macular and leucomatous types; nebular opacity being the most common. Trauma was the most common cause of opacity followed by infective keratitis. Intra-operative complication rate was 4.89%; which included-7 posterior capsular rent with vitreous disturbance, 2 zonular dialysis, 2 iridodialysis, 2 eyes with aphakia and 1 with Descemet membrane detachment. On follow-up, 6 patients had decentered intraocular lens and 10 had residual cortex. Median logMAR vision improved significantly (p < 0.001) from 1.08 (5/60) pre-operatively to 0.3 (6/12) post-operatively. MSCIS is efficient in providing favorable visual outcomes in patients where corneal opacity makes it difficult for the surgeon to perform a phacoemulsification surgery.

Outcomes of Descemet's membrane keratoplasty in graft failure after penetrating keratoplasty.

To analyze the outcomes and identify the risk factors of failure in Descemet's membrane endothelial keratoplasty (DMEK) for graft failure after penetrating keratoplasty (PKP). Medical records and surgical videos of patients who underwent DMEK for graft failure after PKP were reviewed in this retrospective study. Demographic data, the indication for PKP, number of previous PKPs, duration between the last PKP and graft failure, graft diameter at the last PKP, best-corrected visual acuity (logMAR) before and after DMEK, preoperative additional ocular diseases, and intraoperative and postoperative complications were recorded. Descemet's membrane (DM) attachment was examined on the first day and the first month, postoperatively, and at the last follow-up visit. The patients were divided into two groups according to DM attachment at the last visit (group 1, patients with attached DM; group 2, patients with DM detachment). Twenty eyes of 20 patients were included in this study. At the last follow-up visit, DM was attached in 13 (65%) patients (Group 1) and detached in 7 (35%) cases (Group 2). The BCVA was improved significantly after DMEK in all patients (2.10 ± 0.4, preoperatively; 1.09 ± 0.8, postoperatively; p = 0.005). There were no significant differences between groups, in terms of age, the number and indication for PKP, the time between the last PKP and DMEK, or history of glaucoma. PKP was performed in all patients in group 2. DMEK is a feasible option with fast visual recovery and a low risk of complications in patients with graft failure after PKP. We found no risk factors for the DM graft detachment, so larger studies are needed to analyze intraoperative or donor-related factors as well.

Bedside anterior segment optical coherence tomography-assisted reattachment of severe hemorrhagic Descemet's membrane detachment after ab externo 360-degree suture trabeculotomy combined with trabeculectomy.

Bedside anterior segment optical coherence tomography-assisted reattachment of severe hemorrhagic Descemet's membrane detachment after ab externo 360-degree suture trabeculotomy combined with trabeculectomy.

A Clinical Study on Risk Factors of Descemets Membrane Detatchment and Visual Outcome Following Air Descemetopexy for Post Cataract Surgery Descemets Membrane Detatchment

Background: To study Risk factors, incidence of Descemets membrane detachment (DMD) and visual outcome following Air Descemetopexy for post cataract surgery DMD. Methods: This study is a type of prospective study conducted in 20 patients who underwent Air Descemetopexy for post cataract surgery descemet’s membrane detachment .20 patients were included in the study who had DMD out of 614 manual small incision cataract surgery (MSICS) and 160 Phacoemulsification during the period, June 2022 to December 2022. A clinical analysis on risk factors, corneal comorbidities, incidence and visual outcome were studied. Results: Mean age of patients was 62.5 years, 40% are males and 60% are females. Incidence of DMD in MSICS was 0.72% and in Phacoemulsification was 0.06%. corneal degenerations and opacities, pseudo exfoliation(PXF), dense cataracts, shallow anterior chamber, phacomorphic glaucoma are the most common risk factors and DMD was higher among Surgical trainees than consultants. 80% of patients has vision better than 6/18 at the end of one month post operatively. Almost 97% patients had successful reattachment. Conclusion: The results of this case series suggests that DMD is a surgeon induced preventable cause for postoperative corneal edema, Early detection and judicious management reduces the incidence and improves visual outcome. Air Descemetopexy is safe and efficient modality of treatment for DMD and should be tried in patients with moderate and severe DMD before opting for major surgeries like Endothelial Keratoplasty as final treatment of choice

Intracameral Sulfur Hexafluoride Gas Injection and Descemet Membrane Endothelial Keratoplasty for Treatment of Descemet Membrane Detachment After Phacoemulsification Surgery

Intracameral Sulfur Hexafluoride Gas Injection and Descemet Membrane Endothelial Keratoplasty for Treatment of Descemet Membrane Detachment After Phacoemulsification Surgery