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Romano D, Aiello F, Parekh M, Levis HJ, Gadhvi KA, Moramarco A, Viola P, Fontana L, Semeraro F, Romano V. Incidence and management of early postoperative complications in lamellar corneal transplantation. Graefes Arch Clin Exp Ophthalmol 2023; 261:3097-3111. [PMID: 37103622 PMCID: PMC10134734 DOI: 10.1007/s00417-023-06073-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 03/09/2023] [Accepted: 04/16/2023] [Indexed: 04/28/2023] Open
Abstract
PURPOSE To provide a comprehensive review of the incidence, risk factors, and management of early complications after deep anterior lamellar keratoplasty (DALK), Descemet stripping automated keratoplasty (DSAEK), and Descemet membrane endothelial keratoplasty (DMEK). METHODS A literature review of complications, that can occur from the time of the transplant up to 1 month after the transplant procedure, was conducted. Case reports and case series were included in the review. RESULTS Complications in the earliest postoperative days following anterior and posterior lamellar keratoplasty have shown to affect graft survival. These complications include, but are not limited to, double anterior chamber, sclerokeratitis endothelial graft detachment, acute glaucoma, fluid misdirection syndrome, donor-transmitted and recurrent infection, and Uretts-Zavalia syndrome. CONCLUSION It is essential for surgeons and clinicians to not only be aware of these complications but also know how to manage them to minimize their impact on long-term transplant survival and visual outcomes.
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Affiliation(s)
- Davide Romano
- Ophthalmology Department, University Hospitals of Leicester NHS Trust, Leicester, UK
- Eye Clinic, ASST Spedali Civili Di Bescia, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia Medical School, Piazzale Spedali Civili, 1, 25125, Brescia, Italy
| | - Francesco Aiello
- Ophthalmology Unit, Department of Experimental Medicine, University of Rome "Tor Vergata", Rome, Italy
| | - Mohit Parekh
- Department of Ophthalmology, Schepens Eye Research Institute, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA
| | - Hannah J Levis
- Department of Eye and Vision Science, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK
| | - Kunal A Gadhvi
- Department of Corneal Diseases, St. Paul's Eye Unit, Royal Liverpool University Hospital, Liverpool, UK
| | - Antonio Moramarco
- Ophthalmology Unit, IRCCS Azienda Ospedaliero-Universitaria Di Bologna, Bologna, Italy
| | - Pietro Viola
- Department of Ophthalmology, San Bartolo Hospital, Vicenza, Italy
| | - Luigi Fontana
- Ophthalmology Unit, IRCCS Azienda Ospedaliero-Universitaria Di Bologna, Bologna, Italy
| | - Francesco Semeraro
- Eye Clinic, ASST Spedali Civili Di Bescia, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia Medical School, Piazzale Spedali Civili, 1, 25125, Brescia, Italy
| | - Vito Romano
- Eye Clinic, ASST Spedali Civili Di Bescia, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia Medical School, Piazzale Spedali Civili, 1, 25125, Brescia, Italy.
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Borkenstein AF, Packard R, Dhubhghaill SN, Lockington D, Donnenfeld ED, Borkenstein EM. Clear corneal incision, an important step in modern cataract surgery: a review. Eye (Lond) 2023; 37:2864-2876. [PMID: 36788364 PMCID: PMC10516977 DOI: 10.1038/s41433-023-02440-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Revised: 12/29/2022] [Accepted: 02/01/2023] [Indexed: 02/16/2023] Open
Abstract
A clear corneal incision (CCI) is the most commonly used entrance site in modern phacoemulsification cataract surgery. Despite some initial concerns about increased endophthalmitis rates through a self-sealing CCI, recent literature suggests that the risk of infection with proper wound construction and all other necessary precautions is minimal. The technique of creating a clear corneal incision has, with recent developments in corneal imaging, undergone critical appraisal leading to a better understanding of incision architecture. Many surgeons operate through smaller incisions, and they have a wide choice of surgical instruments to create their corneal incisions. The aim of this review is to discuss the history and the current status of clear corneal incision creation, the design and materials of surgical blades, and the current trends in manufacturing and sustainability. Although disposable instruments have some advantages and are very popular, recycling, if possible, and avoiding unnecessary plastic waste are important considerations. In any case, the step of CCI is a small one for the surgeon, but a big one for the eye. That is why it has to be done with the utmost precision and in-depth knowledge is important.
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Affiliation(s)
- Andreas F Borkenstein
- Borkenstein and Borkenstein, Private Practice at Privatklinik Kreuzschwestern, Graz, Austria.
| | | | | | - David Lockington
- Tennent Institute of Ophthalmology, Gartnavel General Hospital, Glasgow, UK
| | | | - Eva-Maria Borkenstein
- Borkenstein and Borkenstein, Private Practice at Privatklinik Kreuzschwestern, Graz, Austria
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Trindade LC, Attanasio de Rezende R, Bisol T, J Rapuano C. Late Descemet membrane detachment after uneventful cataract surgery. Am J Ophthalmol Case Rep 2022; 29:101783. [PMID: 36632336 PMCID: PMC9827023 DOI: 10.1016/j.ajoc.2022.101783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Revised: 12/14/2022] [Accepted: 12/18/2022] [Indexed: 12/24/2022] Open
Abstract
Purpose To report 5 patients with late Descemet membrane (DM) detachment after uneventful cataract surgery. Observations After a retrospective chart analysis of consecutive patients that developed DM detachment after uneventful cataract surgery, six eyes of five patients were enrolled. In all cases, patients reported good vision initially after cataract surgery. Within days to months, these patients developed late DM detachment with decreased vision. In one patient, the detachment affected both eyes. Filtered air or diluted sulfur hexafluoride were injected in the anterior chamber to tamponade the DM detachment. In five eyes, the cornea cleared after DM reattachment. In two eyes of the same patient, DM reattached spontaneously requiring no further surgical intervention. In one patient, the Descemet failed to reattach and required an endothelial keratoplasty. Conclusion and importance Descemet membrane detachment may occur after uneventful cataract surgery. Filtered air or long-lasting intraocular gas may be used to reattach DM. Spontaneous DM reattachment may also occur and surgeons should be aware of this to avoid unnecessary procedures.
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Affiliation(s)
- Lovaglio Cançado Trindade
- Medical Sciences Medical School–FELUMA, Belo Horizonte, Brazil,Medical Sciences Eye Institute–FELUMA, Belo Horizonte, Brazil,Cançado-Trindade Eye Institute, Belo Horizonte, Brazil,Corresponding author. Rua Manaus 595, São Lucas - 30.150-350, Belo Horizonte, MG, Brazil.
| | - Renata Attanasio de Rezende
- PUC-Rio University, Rio de Janeiro, Brazil,Instituto de Diagnóstico e Terapia Ocular, Rio de Janeiro, Brazil,São Vicente de Paulo Hospital, Rio de Janeiro, Brazil
| | - Tiago Bisol
- PUC-Rio University, Rio de Janeiro, Brazil,Instituto de Diagnóstico e Terapia Ocular, Rio de Janeiro, Brazil,São Vicente de Paulo Hospital, Rio de Janeiro, Brazil
| | - Christopher J Rapuano
- Wills Eye Hospital, Philadelphia, PA, USA,Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, PA, USA
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Eguchi M, Sakaguchi H, Shiraki A, Soma T, Miki A, Nishida K. Treatment of Descemet's membrane detachment after primary Descemet's stripping automated endothelial keratoplasty during surgery using intraoperative optical coherence tomography. Am J Ophthalmol Case Rep 2022; 27:101623. [PMID: 35761877 PMCID: PMC9233229 DOI: 10.1016/j.ajoc.2022.101623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Revised: 05/30/2022] [Accepted: 06/06/2022] [Indexed: 11/04/2022] Open
Abstract
Purpose To present a novel microscope-integrated optical coherence tomography (iOCT)-guided surgical technique wherein Descemet's membrane detachment (DMD), occurring during vitrectomy, was treated intraoperatively in a patient who had previously undergone Descemet's stripping automated endothelial keratoplasty (DSAEK). Observations The surgical technique was performed on a 75-year-old man with a history of DSAEK to intraoperatively treat DMD, which occurred during vitrectomy in the left eye. A fine needle mounted on a syringe was inserted into the supra-Descemet's space under iOCT guidance. The location of the needle was easily identified by its high reflection. The interface fluid was safely aspirated under excellent visualization of the needle tip and the interface. Successful aspiration of the interface fluid was confirmed via iOCT imaging at the end of the surgery. The graft has remained well attached to the cornea throughout the one-year postoperative follow-up. Conclusion and importance iOCT-guided surgical interventions provide a safe and accurate approach for treating intraoperative complications in eyes with a history of DSAEK.
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Singh P, Sinha A, Nagpal R, Chaurasia S. Descemet membrane endothelial keratoplasty: Update on preoperative considerations, surgical techniques, and outcomes. Indian J Ophthalmol 2022; 70:3222-3238. [PMID: 36018091 DOI: 10.4103/ijo.ijo_2933_21] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Descemet membrane endothelial keratoplasty (DMEK) is the closest to the physiological replacement of endothelial cells. In the initial years, the technique was surgically challenging. Over the years, with better understanding and modifications in the surgical steps, the technique has evolved as an alternative to more popular procedure Descemet stripping endothelial keratoplasty. The article highlights the various preoperative, intraoperative, and postoperative nuances of DMEK. Additionally, it summarizes the various comparative and noncomparative studies on DMEK outcomes.
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Affiliation(s)
- Prabhakar Singh
- Department of Cornea and Anterior Segment, All India Institute of Medical Sciences, Patna, Bihar, India
| | - Akanksha Sinha
- Cornea and Anterior Segment, Sankara Eye Hospital, Kanpur, Uttar Pradesh, India
| | - Ritu Nagpal
- Research Officer, All India Institute of Medical Sciences, New Delhi, India
| | - Sunita Chaurasia
- Cornea and Anterior Segment Services, L V Prasad Eye Institute, Hyderabad, Telangana, India
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Maheshwari D, Pillai MR, Segi A, Tara TD, Rengappa R. Spontaneous resolution of Descemet's membrane detachment following bleb needling in a patient with iridocorneal endothelial syndrome: A case report. Indian J Ophthalmol 2022; 70:2639-2641. [PMID: 35791183 PMCID: PMC9426115 DOI: 10.4103/ijo.ijo_3203_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Affiliation(s)
- Devendra Maheshwari
- Department of Glaucoma, Aravind Eye Hospital, Post Graduate Institute of Ophthalmology, Tirunelveli, Tamil Nadu, India
| | - Madhavi Ramanatha Pillai
- Department of Glaucoma, Aravind Eye Hospital, Post Graduate Institute of Ophthalmology, Tirunelveli, Tamil Nadu, India
| | - Ashwin Segi
- Department of Glaucoma, Aravind Eye Hospital, Post Graduate Institute of Ophthalmology, Tirunelveli, Tamil Nadu, India
| | - Techi Dodum Tara
- Department of Glaucoma, Aravind Eye Hospital, Post Graduate Institute of Ophthalmology, Tirunelveli, Tamil Nadu, India
| | - Ramakrishnan Rengappa
- Department of Glaucoma, Aravind Eye Hospital, Post Graduate Institute of Ophthalmology, Tirunelveli, Tamil Nadu, India
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Spontaneous resolution of recurrent Descemet's membrane detachment after trabeculectomy: A case report. Am J Ophthalmol Case Rep 2022; 25:101276. [PMID: 35146182 PMCID: PMC8818486 DOI: 10.1016/j.ajoc.2022.101276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 01/13/2022] [Accepted: 01/14/2022] [Indexed: 11/23/2022] Open
Abstract
Purpose We report a rare case of recurrent Descemet's membrane detachment (DMD) post-trabeculectomy which was resolved spontaneously without surgical intervention. Observations A 66-year-old patient with a history of acute angle closure glaucoma in his right eye presented to our hospital. The intraocular pressure (IOP) of his right was 40 mm Hg, and the visual acuity was10/20. After trabeculectomy of the affected eye, a severe Descemet's membrane detachment was found by AS-OCT. Part of Descemet's membrane was lying in front of the iris and lens. Surgical repair was performed, and viscoelastics and sterile air were injected into the anterior chamber to return the detached Descemet's membrane. AS-OCT showed that the DMD was successfully resolved. However, on the 7th day of follow-up, the DMD was detached again as seen on AS-OCT images. The patient refused reoperation to repair the DMD. Six months later, the patient visited our hospital again, and, interestingly, the DMD was completely resolved spontaneously without reoperation. Conclusions and importance Descemet's membrane is the basement membrane that lies between the stroma and the endothelial layer of the cornea. Minor DMD may be resolved spontaneously within a period of time without surgery, but large DMD is difficult to recover spontaneously. We believe that this is a rare case with spontaneous recovery of extensive DMD after trabeculectomy. But, despite all this, we still remain of the view that DMD should be treated immediately once it occurs.
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Rodriguez Galarza RM, McMullen RJ. Descemet's membrane detachments, ruptures, and separations in ten adult horses: Clinical signs, diagnostics, treatment options, and preliminary results. Vet Ophthalmol 2020; 23:611-623. [PMID: 32529665 DOI: 10.1111/vop.12793] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Revised: 04/27/2020] [Accepted: 05/15/2020] [Indexed: 12/18/2022]
Abstract
OBJECTIVE To describe the clinical presentation, diagnostic imaging results, and treatment outcomes of a series of presumed spontaneous Descemet's membrane detachments (DMD), ruptures, or separations (DMRS) in the adult horse. ANIMALS STUDIED Ten adult horses of various breeds with DMD or DMRS. PROCEDURES Descemet's membrane detachments/DMRS were diagnosed via slit lamp biomicroscopy, ultrasound biomicroscopy (UBM), and/or optical coherence tomography (OCT). Penetrating keratoplasty (PK) with heterologous corneal donor tissue (n = 1), superficial lamellar keratectomy, and Gundersen inlay flaps alone (GF, n = 1) or with subsequent intracamerally assisted corneal tissue welding (CTW, n = 2), or CTW alone (n = 5) were performed in 9/10 horses. One horse underwent spontaneous resolution (n = 1). RESULTS Ten horses were diagnosed with either unilateral DMD (n = 4) or DMRS (n = 6). Seven of ten eyes remained visual during the follow-up period (8.16 ± 6.57 months). Graft transparency was good for the eye treated with PK. The horse that underwent GF alone was functionally blind due to persistent corneal edema. The clinical signs resolved in 3/5 horses that underwent CTW alone, but 2/5 eyes were enucleated due to corneal perforation. Both eyes treated with combined GF/CTW had significant corneal clearing with one having evidence of reattachment on UBM and OCT. CONCLUSIONS Descemet's membrane detachments separations presents differently than typical DMD and advanced corneal imaging modalities may aid in their diagnosis. Corneal tissue welding using infraCG as the photosensitive agent, or in combination with Gundersen inlay flaps, represents a feasible treatment option for management of equine DMD/DMRS as described in the present case series.
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Affiliation(s)
| | - Richard J McMullen
- JT Vaughan Large Animal Teaching Hospital, Auburn University College of Veterinary Medicine, Auburn, AL, USA
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9
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Management of Descemet’s Membrane Detachment after Cataract Surgery—A Case Series. REPORTS 2020. [DOI: 10.3390/reports3020013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Descemet’s membrane detachment (DMD) is an uncommon, vision-threatening, ocular surface complication of cataract surgery. Among several treatment strategies, sulfur hexafluoride (SF6) descemetopexy is the standard of care. Herein, we report three cases of DMD after cataract surgery managed with SF6 descemetopexy, showing different outcomes. Anatomical success was achieved in cases 1 and 2 while intraocular pressure (IOP) was elevated in case 2. In case 3, despite SF6 descemetopexy, recurrent DMD was observed. Due to persistent corneal edema and possible corneal decompensation in case 3, Descemet’s stripping automated endothelial keratoplasty was performed and a clear graft was found at the final visit. In conclusion, descemetopexy with 20 % SF6 is an effective and safe procedure for repairing DMD in most cases. Pupillary block with elevated IOP is another concern and prophylactic peripheral iridectomy is recommended. For recurrent DMDs, repeat descemetopexy could be considered. However, close monitoring is advocated since secondary management, such as endothelial keratoplasty, may be required.
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10
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[Persisting corneal edema after uncomplicated cataract surgery]. Ophthalmologe 2020; 117:802-805. [PMID: 32125495 DOI: 10.1007/s00347-020-01041-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Singhal D, Sahay P, Goel S, Asif MI, Maharana PK, Sharma N. Descemet membrane detachment. Surv Ophthalmol 2020; 65:279-293. [PMID: 31923476 DOI: 10.1016/j.survophthal.2019.12.006] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Revised: 12/27/2019] [Accepted: 12/30/2019] [Indexed: 10/25/2022]
Abstract
Descemet membrane detachment (DMD) is a potential vision-threatening complication that occurs most commonly after cataract surgery. DMD has also been reported to occur in various other surgeries such as keratoplasty, iridectomy, vitrectomy, trabeculectomy, holmium laser sclerostomy, alkali burn, and viscocanalostomy. Major risk factors include advanced age, preexisting endothelial diseases like Fuchs dystrophy or abnormality in the Descemet membrane and stromal interface, hard cataract, prolonged surgical time, ragged clear corneal incisions, and inadvertent trauma with blunt instruments or phacoemulsification probe. Most DMDs are peripheral and resolve spontaneously. Large, central DMDs if not managed appropriately may lead to corneal decompensation and opacification. Several authors have classified DMD depending on its configuration, height, extent, length, and position with respect to pupil. Anterior segment optical coherence tomography has been used to confirm and classify DMD and can also aid in deciding the management plan. Spontaneous reattachment of the DM with conservative management may occur in cases with small, peripheral, planar DMD with nonscrolled edges. Cases with nonplanar, central DMD, scrolled edges, and length >2 mm, however, have to be managed surgically. Descemetopexy is the gold standard for the management of DMD. Other management options include mechanical tamponade, suture fixation, descemetotomy, interface drainage, and keratoplasty. Prompt diagnosis and timely management often leads to a good visual outcome.
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Affiliation(s)
- Deepali Singhal
- Department of Ophthalmology, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Pranita Sahay
- Department of Ophthalmology, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Siddhi Goel
- Department of Ophthalmology, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Mohamed Ibrahime Asif
- Department of Ophthalmology, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Prafulla K Maharana
- Department of Ophthalmology, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Namrata Sharma
- Department of Ophthalmology, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India.
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Xia X, Atkins M, Dalal R, Kuzmenko O, Chang KC, Sun CB, Benatti CA, Rak DJ, Nahmou M, Kunzevitzky NJ, Goldberg JL. Magnetic Human Corneal Endothelial Cell Transplant: Delivery, Retention, and Short-Term Efficacy. Invest Ophthalmol Vis Sci 2019; 60:2438-2448. [PMID: 31158276 PMCID: PMC6546151 DOI: 10.1167/iovs.18-26001] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Purpose Corneal endothelial dysfunction leads to corneal edema, pain, and vision loss. Adequate animal models are needed to study the safety and efficacy of novel cell therapies as an alternative to corneal transplantation. Methods Primary human corneal endothelial cells (HCECs) were isolated from cadaveric donor corneas, expanded in vitro, transduced to express green fluorescent protein (GFP), loaded with superparamagnetic nanoparticles, and injected into the anterior chamber of adult rabbits immediately after endothelial cell or Descemet's membrane stripping. The same volume of balanced salt solution plus (BSS+) was injected in control eyes. We compared different models for inducing corneal edema in rabbits, and examined the ability of transplanted HCECs to reduce corneal edema over time by measuring central corneal thickness and tracking corneal clarity. GFP-positive donor cells were tracked in vivo using optical coherence tomography (OCT) fluorescence angiography module, and the transplanted cells were confirmed by human nuclei immunostaining. Results Magnetic HCECs integrated onto the recipient corneas with intact Descemet's membrane, and donor identity was confirmed by GFP expression and immunostaining for human nuclei marker. Donor HCECs formed a monolayer on the posterior corneal surface and expressed HCEC functional markers of tight junction formation. No GFP-positive cells were observed in the trabecular meshwork or on the iris, and intraocular pressure remained stable through the length of the study. Conclusions Our results demonstrate magnetic cell-based therapy efficiently delivers HCECs to restore corneal transparency without detectable toxicity or adverse effect on intraocular pressure. Magnetic delivery of HCECs may enhance corneal function and should be explored further for human therapies.
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Affiliation(s)
- Xin Xia
- Byers Eye Institute and Spencer Center for Vision Research, Department of Ophthalmology, Stanford University, Palo Alto, California, United States
| | - Melissa Atkins
- Byers Eye Institute and Spencer Center for Vision Research, Department of Ophthalmology, Stanford University, Palo Alto, California, United States
| | - Roopa Dalal
- Byers Eye Institute and Spencer Center for Vision Research, Department of Ophthalmology, Stanford University, Palo Alto, California, United States
| | - Olga Kuzmenko
- Byers Eye Institute and Spencer Center for Vision Research, Department of Ophthalmology, Stanford University, Palo Alto, California, United States
| | - Kun-Che Chang
- Byers Eye Institute and Spencer Center for Vision Research, Department of Ophthalmology, Stanford University, Palo Alto, California, United States
| | - Catalina B Sun
- Byers Eye Institute and Spencer Center for Vision Research, Department of Ophthalmology, Stanford University, Palo Alto, California, United States
| | - C Andres Benatti
- Shiley Eye Center, University of California, San Diego, La Jolla, California, United States
| | - Dillon J Rak
- Shiley Eye Center, University of California, San Diego, La Jolla, California, United States
| | - Michael Nahmou
- Byers Eye Institute and Spencer Center for Vision Research, Department of Ophthalmology, Stanford University, Palo Alto, California, United States
| | - Noelia J Kunzevitzky
- Byers Eye Institute and Spencer Center for Vision Research, Department of Ophthalmology, Stanford University, Palo Alto, California, United States.,Shiley Eye Center, University of California, San Diego, La Jolla, California, United States.,Emmecell, Menlo Park, California, United States
| | - Jeffrey L Goldberg
- Byers Eye Institute and Spencer Center for Vision Research, Department of Ophthalmology, Stanford University, Palo Alto, California, United States.,Shiley Eye Center, University of California, San Diego, La Jolla, California, United States
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13
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Bowden EC, Vinod K, Sidoti PA, Panarelli JF. Descemet's membrane detachment following an intracameral injection of viscoelastic. Am J Ophthalmol Case Rep 2019; 16:100466. [PMID: 31453410 PMCID: PMC6700441 DOI: 10.1016/j.ajoc.2019.100466] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Revised: 01/06/2019] [Indexed: 11/17/2022] Open
Affiliation(s)
- Eileen Choudhury Bowden
- Department of Ophthalmology, New York Eye and Ear Infirmary of Mount Sinai and Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Kateki Vinod
- Department of Ophthalmology, New York Eye and Ear Infirmary of Mount Sinai and Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Paul A. Sidoti
- Department of Ophthalmology, New York Eye and Ear Infirmary of Mount Sinai and Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Joseph F. Panarelli
- NYU Langone Eye Center, New York University School of Medicine, New York, NY, USA
- Corresponding author.
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14
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Slenter IJM, Hermans H, Ensink JM, Willems DS, Veraa S, Grinwis GCM, Boevé MH. Clinical, ultrasonographic, and histopathologic findings in seven horses with Descemet's membrane detachment: A case series. Vet Ophthalmol 2019; 23:181-189. [PMID: 31544302 PMCID: PMC7003845 DOI: 10.1111/vop.12710] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2018] [Revised: 08/16/2019] [Accepted: 08/23/2019] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To describe ultrasonography as a diagnostic method of in vivo Descemet's membrane detachment (DMD) in horses. ANIMALS STUDIED Seven horses (three Icelandic horses, two Dutch Warmblood horses, one Appaloosa, and one Welsh Pony), presenting with moderate-to-severe focal or diffuse corneal edema, in whom DMD was suspected on ultrasonographic examination and confirmed with histopathology, were studied. PROCEDURE A retrospective analysis of case records of horses with suspected DMD was performed. RESULTS Median age at presentation was 14 years (range 11-24). Clinical signs in eyes with DMD were unilateral in all horses and included blepharospasm and epiphora (6/7), buphthalmos (5/7), moderate-to-severe focal or diffuse corneal edema (7/7), corneal epithelial bullae (4/7), corneal neovascularization (4/7), Haab's striae (2/7), corneal endothelial precipitates (1/7), fibrin in the anterior chamber (1/7), focal cataract (2/7), and pigment deposits on the anterior lens capsule (1/7). During transpalpebral ultrasonography, a distinct linear echogenic structure was noted in the anterior chamber, initially diverging from, and later running parallel to, the posterior lining of the cornea in all eyes studied. In all cases, the cornea was severely thickened and echogenic, consistent with edema, and DMD was suspected. In all horses, the clinical signs progressed and the affected eye was eventually enucleated. Histopathology revealed DMD (7/7), spindle cell proliferation (4/7), Descemet's membrane reformation (3/7), and inflammation of the anterior uvea (5/7). Overall incidence was 1.04%. CONCLUSIONS Ultrasonography is an adequate tool in diagnosing DMD in horses. Descemet's membrane detachment should be included in the differential diagnosis in horses with dense focal or diffuse corneal edema.
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Affiliation(s)
- Inge J M Slenter
- Faculty of Veterinary Medicine, Department of Clinical Sciences of Companion Animals, Ophthalmology Section, Utrecht University, Utrecht, The Netherlands
| | - Hanneke Hermans
- Faculty of Veterinary Medicine, Department of Equine Sciences, Surgery Section, Utrecht University, Utrecht, The Netherlands
| | - Jos M Ensink
- Faculty of Veterinary Medicine, Department of Equine Sciences, Surgery Section, Utrecht University, Utrecht, The Netherlands
| | - Dorien S Willems
- Faculty of Veterinary Medicine Department of Clinical Sciences of Companion Animals, Diagnostic Imaging, Utrecht University, Utrecht, The Netherlands
| | - Stefanie Veraa
- Faculty of Veterinary Medicine Department of Clinical Sciences of Companion Animals, Diagnostic Imaging, Utrecht University, Utrecht, The Netherlands
| | - Guy C M Grinwis
- Faculty of Veterinary Medicine, Department of Pathobiology, Utrecht University, Utrecht, The Netherlands
| | - Michael H Boevé
- Faculty of Veterinary Medicine, Department of Clinical Sciences of Companion Animals, Ophthalmology Section, Utrecht University, Utrecht, The Netherlands
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Meena AK, Ghodke BR, Parmar GS. Central retinal artery occlusion after Descemet membrane reposition by intracameral air: A case report. Eur J Ophthalmol 2019; 31:NP77-NP80. [PMID: 31432690 DOI: 10.1177/1120672119870740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE To report a case of central retinal artery occlusion after Descemet membrane reposition by intracameral air. METHODS An otherwise healthy 60-year-old woman presented with white mature cataract in her left eye. Ocular exam of both eyes was within normal limits. After an uneventful topical phacoemulsification, a moderate-grade striate keratopathy and non-planar Descemet membrane detachment was noted on first postoperative day, which was confirmed on anterior segment optical coherence tomography. The Descemet membrane was repositioned within 24 h of cataract extraction by intracameral air tamponade (pneumatic descematopexy) under topical anesthesia, and partial air release was done after 2 h. The patient was evaluated for decreased immediate postoperative vision of perception of light. RESULTS After pneumatic descematopexy, the stromal edema relatively cleared. The intraocular pressure before releasing the intracameral air was 38 mmHg and antiglaucoma medication was started. Dilated fundus exam showed retinal pallor and a cherry-red spot over the macula. A diagnosis of central retinal artery occlusion was confirmed, and thorough systemic workup was done. Systemic investigations were within normal limits. The patient was managed conservatively, but the final visual acuity remained at 1/60. CONCLUSION Central retinal artery occlusion is not a reported complication after pneumatic descematopexy for Descemet membrane detachment management. The possible mechanism could be sudden increase in intraocular pressure due to pupil block by air, and thus, ocular surgeries with use of intracameral air for prolonged duration warrants close monitoring of intraocular pressure and its subsequent management.
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Affiliation(s)
- Ashok Kumar Meena
- Department of Cornea and Refractive Surgery, Shri Sadguru Seva Sangh Trust, Chitrakoot, India
| | - Bhushan R Ghodke
- Department of Cornea and Refractive Surgery, Shri Sadguru Seva Sangh Trust, Chitrakoot, India
| | - Gautam Singh Parmar
- Department of Cornea and Refractive Surgery, Shri Sadguru Seva Sangh Trust, Chitrakoot, India
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AlZaid A, AlDarrab A, Malik R, Owaidhah O. Ocular coherence tomography for the diagnosis of Descemet's detachment after deep sclerectomy and resolution after intracameral air injection. Am J Ophthalmol Case Rep 2019; 15:100509. [PMID: 31388603 PMCID: PMC6676234 DOI: 10.1016/j.ajoc.2019.100509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2018] [Revised: 07/02/2019] [Accepted: 07/05/2019] [Indexed: 11/19/2022] Open
Abstract
Purpose to report the use of optical coherence tomography (OCT) in a case of Descemet's membrane detachment (DMD) secondary to a nonpenetrating deep sclerectomy (NPDS) and the efficacy of intracameral air injection for management. Observations DMD was identified by anterior segment OCT (AS-OCT) in a 61-year-old male patient who was blind in the right eye and had advanced open angle glaucoma. This patient underwent NPDS in the left eye and developed localized corneal edema postoperatively. Air was injected into the anterior chamber resulting in reattachment of Descemet's membrane and resolution of corneal edema. Conclusions and Importance This case highlights the need for a high suspicion of DMD in cases of localized corneal edema after non-penetrating surgery. Following confirmation with AS-OCT, DMD can be successfully managed with air injection. DMD is a rare complication of NPDS with all the reported cases associated with implant. To the best of our knowledge, this is the first case report of NPDS without any type of implant.
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Affiliation(s)
- Abdulrahman AlZaid
- Vitreoretinal Division, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia
- Corresponding author.
| | - Abdulrahman AlDarrab
- Glaucoma Division, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia
- Department of Surgery, College of Medicine, Prince Sattam Bin Abdulaziz University, Alkharj, Saudi Arabia
| | - Rizwan Malik
- Glaucoma Division, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia
| | - Ohoud Owaidhah
- Glaucoma Division, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia
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Kocak Altintas AG, Ilhan C. Successful treatment of late onset post-phacoemulsification Descemet's membrane detachment. Ther Adv Ophthalmol 2019; 11:2515841419853691. [PMID: 31218275 PMCID: PMC6557015 DOI: 10.1177/2515841419853691] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Accepted: 05/08/2019] [Indexed: 11/15/2022] Open
Abstract
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.
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Affiliation(s)
- Ayse Gul Kocak Altintas
- Associated Professor, University of Health Sciences, Ankara Ulucanlar Eye Education and Research Hospital, Ulucanlar Cad. No: 59, 06230 Ankara, Altindag, Turkey
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Francois J, Vermion JC, Hayek G, Semler Collery A, Chaussard D, Bloch F, Dubroux C, Lakehal Ayat Y, Lhuillier L, Zaidi M, Perone JM. Management of large central Descemet membrane detachment (DMD) after cataract surgery: Case report and literature review. J Fr Ophtalmol 2019; 42:e271-e278. [PMID: 31029471 DOI: 10.1016/j.jfo.2018.09.024] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2018] [Revised: 09/04/2018] [Accepted: 09/12/2018] [Indexed: 11/16/2022]
Affiliation(s)
- J Francois
- Département d'ophtalmologie, hôpital de Mercy, CHR Metz-Thionville, 1, allée du château, CS 45001, 57085 Metz cedex 03, France
| | - J-C Vermion
- Département d'ophtalmologie, hôpital de Mercy, CHR Metz-Thionville, 1, allée du château, CS 45001, 57085 Metz cedex 03, France
| | - G Hayek
- Département d'ophtalmologie, hôpital de Mercy, CHR Metz-Thionville, 1, allée du château, CS 45001, 57085 Metz cedex 03, France
| | - A Semler Collery
- Département d'ophtalmologie, hôpital de Mercy, CHR Metz-Thionville, 1, allée du château, CS 45001, 57085 Metz cedex 03, France
| | - D Chaussard
- Département d'ophtalmologie, hôpital de Mercy, CHR Metz-Thionville, 1, allée du château, CS 45001, 57085 Metz cedex 03, France
| | - F Bloch
- Département d'ophtalmologie, hôpital de Mercy, CHR Metz-Thionville, 1, allée du château, CS 45001, 57085 Metz cedex 03, France
| | - C Dubroux
- Département d'ophtalmologie, hôpital de Mercy, CHR Metz-Thionville, 1, allée du château, CS 45001, 57085 Metz cedex 03, France
| | - Y Lakehal Ayat
- Département d'ophtalmologie, hôpital de Mercy, CHR Metz-Thionville, 1, allée du château, CS 45001, 57085 Metz cedex 03, France
| | - L Lhuillier
- Département d'ophtalmologie, hôpital de Mercy, CHR Metz-Thionville, 1, allée du château, CS 45001, 57085 Metz cedex 03, France
| | - M Zaidi
- Département d'ophtalmologie, hôpital de Mercy, CHR Metz-Thionville, 1, allée du château, CS 45001, 57085 Metz cedex 03, France
| | - J M Perone
- Département d'ophtalmologie, hôpital de Mercy, CHR Metz-Thionville, 1, allée du château, CS 45001, 57085 Metz cedex 03, France.
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Pujari A, Swamy DR, Chaniyara MH, Sharma N. Intraoperative Descemet's membrane detachment in a case of phacomorphic glaucoma. BMJ Case Rep 2018; 2018:bcr-2018-225593. [PMID: 30344145 DOI: 10.1136/bcr-2018-225593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
A 60-year-old female patient with phacomorphic glaucoma underwent initial medical management to control the intraocular pressure (IOP). After 48 hours, a stable IOP was achieved and subsequently the patient was planned for phacoemulsification followed by intraocular lens implantation. There was initial difficulty while reconstructing the corneal wounds; however, phacoemulsification and IOL implantation were uneventful but during viscoelastic removal, an inadvertent Descemet's membrane detachment involving the central cornea was noted. Postoperatively corneal oedema persisted till 1 week, following which there was a gradual improvement with topical antibiotics, steroids and hyperosmotic agents. At the end of 6 months, the best corrected visual acuity was 20/25 with a central corneal thickness of 580 µm without any need for additional endothelial replacement surgery.
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Affiliation(s)
- Amar Pujari
- Department of Ophthalmology, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, AIIMS, New Delhi, India
| | - Deepa R Swamy
- Department of Ophthalmology, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, AIIMS, New Delhi, India
| | | | - Namrata Sharma
- Department of Ophthalmology, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, AIIMS, New Delhi, India
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20
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Tractional Descemet's membrane detachment after ocular alkali burns: case reports and review of literature. BMC Ophthalmol 2018; 18:256. [PMID: 30249214 PMCID: PMC6154944 DOI: 10.1186/s12886-018-0924-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2018] [Accepted: 09/18/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Descemet's membrane detachment (DMD) is a rare complication after ocular chemical injury and its pathogenesis remains unclear. In this study, we reported two cases of DMD with traction demonstrated on Anterior segment optical coherence tomography (AS-OCT). CASE PRESENTATION Two patients sustained ocular chemical injury with 50% sodium hydroxide. In both cases, AS-OCT revealed detached Descemet's membrane that was adherent to the underlying iris tissue in the inferior quadrant at 45 days and 34 days after the injury respectively. The first case received intracameral tamponade with 12% C3F8 gas and the second case received corticosteroid and sodium chloride 5% eye drops. However, DMD persisted in both cases. CONCLUSIONS The atypical features of DMD on anterior segment optical coherence tomography in our cases suggested the presence of an inflammatory component caused adhesions and traction of iris to Descemet's membrane and prevented reattachment of DMD even with gas tamponade.
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Abstract
RATIONALE Descemet's membrane detachment (DMD) may occur during or following cataract surgery, causing corneal edema and visual loss1. The incidence of DMD after phacoemulsification surgery is only approximately 0.5%, and mostly surgical-related. Late onset bilateral spontaneous DMD after sequential uneventful cataract surgeries, is even rarer, and may result from not only surgery itself, but also from an underlying anatomic abnormality 2. PATIENT CONCERNS We present a 80 year old female developed bilateral descemet's membrane detachment after sequential uncomplicated cataract surgeries. DIAGNOSIS Bilateral Descemet's membrane detachment. INTERVENTIONS One eye (left eye) was treated with intracameral air injection and the fellow eye (right eye) was treated with medical treatment only. OUTCOMES The DMDs were reattached in both eyes after treatment. Surgical intervention accelerated the duration of recovery and there were no significant outcome differences between the right and the left eye. LESSONS Even if there is a large area of DMD with visual axis involvement, conservative treatment with close observation might still provide a satisfactory result if Descemet's membrane is separated from the posterior corneal stroma by ≤1 mm.
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Spontaneous hemorrhagic Descemet membrane detachment causing pupillary block. Eur J Ophthalmol 2018; 22:819-22. [DOI: 10.5301/ejo.5000164] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/12/2012] [Indexed: 11/20/2022]
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Suzuki H, Masuda Y, Hamajima Y, Takahashi H. Irrigation port hydration in phacoemulsification surgery. Clin Ophthalmol 2018; 12:185-190. [PMID: 29398905 PMCID: PMC5775740 DOI: 10.2147/opth.s152798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background In most cases, hydration is performed by water injection into the stromal tissue with a needle. The technique is simple, however it is sometimes troublesome. Purpose We describe a simple technique for hydrating the corneal stroma in cataract surgery using an irrigation port. Patients and methods The technique began by pushing the irrigation port against the corneal stroma for a few seconds during phacoemulsification, which generated edema in the corneal incision that subsequently prevented leakage. This procedure is called the hydration using irrigation port (HYUIP) technique. A total of 60 eyes were randomized and placed in two groups, 30 eyes underwent surgeries using the HYUIP technique (HYUIP group) and 30 eyes underwent surgeries without the HYUIP technique (control). The three points evaluated during each surgery included 1) the occurrence of anterior chamber collapse during the pulling out of the I/A tip after inserting the intraocular lens, 2) the need for conventional hydration, and 3) watertight completion at the end stage of surgery. Results The anterior chamber collapse and the need for conventional hydration were significantly smaller in the HYUIP group compared to the control group. Regarding the self-sealing completion, no significant difference was observed between the two groups. Conclusion The HYUIP technique is an effective method for creating self-sealing wound. In addition, this technique helps to prevent anterior chamber collapse.
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Affiliation(s)
- Hisaharu Suzuki
- Department of Ophthalmology, Nippon Medical School Musashikosugi Hospital, Kawasaki City, Kanagawa
| | - Yoichiro Masuda
- Department of Ophthalmology, The Jikei University, Katsushika Medical Center, Tokyo
| | - Yuki Hamajima
- Department of Ophthalmology, Nippon Medical School Musashikosugi Hospital, Kawasaki City, Kanagawa
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Wylęgała E, Nowińska A. Usefulness of Anterior Segment Optical Coherence Tomography in Descemet Membrane Detachment. Eur J Ophthalmol 2018; 19:723-8. [DOI: 10.1177/112067210901900506] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- E. Wylęgała
- Department of Ophthalmology, District Railway Hospital
- Nursing Department and Social Medical Issues, Health Care Division, Silesian Medical University, Katowice - Poland
| | - A. Nowińska
- Department of Ophthalmology, District Railway Hospital
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Kodama-Takahashi A, Fukuda M, Sugioka K, Kobayashi A, Shimomura Y. Spontaneous reattachment of dislocated endothelial graft after non-Descemet stripping automated endothelial keratoplasty: a case report. BMC Ophthalmol 2018; 18:14. [PMID: 29357819 PMCID: PMC5778650 DOI: 10.1186/s12886-018-0684-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2017] [Accepted: 01/16/2018] [Indexed: 11/23/2022] Open
Abstract
Background Graft detachment is a complication of non-Descemet stripping automated endothelial keratoplasty (nDSAEK). We report a case of spontaneous reattachment of an extensively dislocated graft after nDSAEK. Case presentation A 54-year-old male underwent penetrating keratoplasty (PKP) for keratoconus in his left eye in 2001. Following graft opacity due to rejection, a second PKP was implemented in May 2014. The graft was kept in good condition after the reoperation and yet, visual acuity (VA) declined due to cataract. PEA+IOL was then performed in May 2015. Because edema appeared in the graft 6 months after the PEA+IOL, nDSAEK was carried out in May 2016. Although the donor graft well attached immediately after the nDSAEK, the graft was almost completely dislocated 3 h later except a temporal part. Air was reinjected into the anterior chamber on the following day and the detachment was resolved. Despite of the treatment, about 1/5 of the graft remained detached and the detachment deteriorated to 3/4 of the graft 9 days later. Because the patient could not decide whether to undergo another operation immediately, we decided to follow him up first and found that the partially detached graft reattached spontaneously 1 month later during the follow-up. Although the cornea had a mild edema remaining in the superior temporal area, his BCVA improved to 1.0. Three months later, the graft remained in position and the cornea kept its transparency. Conclusions Spontaneous reattachment was observed during the follow-up in a case that had shown a comparatively extensive graft dislocation after nDSAEK.
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Affiliation(s)
- Aya Kodama-Takahashi
- Department of Ophthalmology, Kindai University Faculty of Medicine, 377-2 Ohno-Higashi, Osaka-Sayama City, Osaka, 589-8511, Japan.
| | - Masahiko Fukuda
- Department of Ophthalmology, Kindai University Faculty of Medicine, 377-2 Ohno-Higashi, Osaka-Sayama City, Osaka, 589-8511, Japan
| | - Koji Sugioka
- Department of Ophthalmology, Kindai University Faculty of Medicine, 377-2 Ohno-Higashi, Osaka-Sayama City, Osaka, 589-8511, Japan
| | - Akira Kobayashi
- Department of Ophthalmology Graduate School of Medical Science, Kanazawa University, 13-1 Takaramachi, Kanazawa City, Ishikawa 920-8641, Japan
| | - Yoshikazu Shimomura
- Department of Ophthalmology, Kindai University Faculty of Medicine, 377-2 Ohno-Higashi, Osaka-Sayama City, Osaka, 589-8511, Japan
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Parekh M, Leon P, Ruzza A, Borroni D, Ferrari S, Ponzin D, Romano V. Graft detachment and rebubbling rate in Descemet membrane endothelial keratoplasty. Surv Ophthalmol 2017; 63:245-250. [PMID: 28739402 DOI: 10.1016/j.survophthal.2017.07.003] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2016] [Revised: 07/13/2017] [Accepted: 07/17/2017] [Indexed: 11/18/2022]
Abstract
Descemet membrane endothelial keratoplasty (DMEK) is a selective replacement of dysfunctional endothelium with healthy donor Descemet membrane and endothelium. Although the donor preparation and surgical methods still remain a challenge, DMEK is gaining popularity in terms of early rehabilitation and visual outcomes. New and improved donor preparation techniques like prestripped DMEK tissues are being taken up rapidly because of less manipulation that is required in the surgical theatre. Donor graft delivery in the recipient eye has also been improved because of new products like prestripped and preloaded membranes. As DMEK is at its budding stage, only early outcomes have been known so far. Early graft detachment, rebubbling rates, and primary failures are still being studied in DMEK. As there are different techniques that are currently used for preparation and injection of the graft, it becomes difficult to judge the results based on specific inclusion and exclusion criteria. Graft detachment and rebubbling rates have been a huge challenge both during the surgery and also while reporting postoperative data. We highlight the importance of defining graft detachment and rebubbling rates and their surgical relevance, which may also have an impact on graft preparation and insertion techniques.
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Affiliation(s)
- Mohit Parekh
- International Center for Ocular Physiopathology, The Veneto Eye Bank Foundation, Mestre, Venice, Italy; Department of Molecular Medicine, School of Biomedicine, University of Padova, Padova, Italy.
| | - Pia Leon
- Department of Ophthalmology, SS Giovanni and Paolo Hospital, Venice, Italy; Department of Ophthalmology, Villa Igea Hospital, Forli, Italy; Istituto Internazionale per la Ricerca e Formazione in Oftalmologia (IRFO), Forlì, Italy
| | - Alessandro Ruzza
- International Center for Ocular Physiopathology, The Veneto Eye Bank Foundation, Mestre, Venice, Italy
| | - Davide Borroni
- Department of Ophthalmology, Riga Stradins University, Riga, Latvia; Department of Genetics, Riga Stradins University, Riga, Latvia
| | - Stefano Ferrari
- International Center for Ocular Physiopathology, The Veneto Eye Bank Foundation, Mestre, Venice, Italy
| | - Diego Ponzin
- International Center for Ocular Physiopathology, The Veneto Eye Bank Foundation, Mestre, Venice, Italy
| | - Vito Romano
- Moorfields Eye Hospital NHS Foundation Trust, London, UK
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Weng Y, Ren YP, Zhang L, Huang XD, Shen-Tu XC. An alternative technique for Descemet's membrane detachment following phacoemulsification: case report and review of literature. BMC Ophthalmol 2017; 17:109. [PMID: 28662635 PMCID: PMC5492398 DOI: 10.1186/s12886-017-0506-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2016] [Accepted: 06/20/2017] [Indexed: 11/25/2022] Open
Abstract
Background Descemet’s membrane detachment (DMD) is one of the most serious complications of modern cataract surgery. We present an alternative technique for management of DMD with a review of the literature on current strategies for the treatment of DMD. Case presentation A 74-year-old woman developed DMD after phacoemulsification and failed the first descemetopexy with air tamponade. An alternative method was used to drain the pre-descematic fluid and reposition the detached Descemet’s membrane in this rare case. This technique involved completely filling the anterior chamber with an intracameral air injection, followed by using a 23-gauge needle to puncture the peripheral cornea to drain the pre-descematic fluid. The Descemet’s membrane was completely reattached to the stroma during the follow-up. Conclusions Drainage of pre-descematic fluid combined with intracameral air tamponading was used as an alternative surgical option for the management of this severe case of DMD.
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Affiliation(s)
- Yan Weng
- Eye Center, the Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, 310009, China
| | - Yu-Ping Ren
- Eye Center, the Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, 310009, China.,Shaoxing Hospital of Traditional Chinese Medicine, Shaoxing, 312000, China
| | - Li Zhang
- Eye Center, the Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, 310009, China
| | - Xiao-Dan Huang
- Eye Center, the Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, 310009, China
| | - Xing-Chao Shen-Tu
- Eye Center, the Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, 310009, China.
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Odayappan A, Shivananda N, Ramakrishnan S, Krishnan T, Nachiappan S, Krishnamurthy S. A retrospective study on the incidence of post-cataract surgery Descemet's membrane detachment and outcome of air descemetopexy. Br J Ophthalmol 2017; 102:182-186. [PMID: 28611131 DOI: 10.1136/bjophthalmol-2016-309766] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2016] [Revised: 05/09/2017] [Accepted: 05/21/2017] [Indexed: 11/04/2022]
Abstract
PURPOSE To study the anatomic and functional outcome of air descemetopexy in postcataract surgery Descemet's membrane detachment (DMD). DESIGN Retrospective study. METHODS Setting: Institutional. STUDY POPULATION Records of 112 patients who underwent air descemetopexy for postcataract surgery sight-threatening DMD at Aravind Eye Hospital, Pondicherry, between January 2013 and December 2015 were studied. MAIN OUTCOME MEASURES Anatomical outcome refers to reattachment of the Descemet's membrane (DM). Functional outcome was given by the best-corrected visual acuity. RESULTS The mean age was 66.47±8.46 (SD) years, the male to female ratio was 45:67. The incidence of DMD was more in extracapsular cataract extraction (0.26%) and manual small incision cataract surgery (0.11%) than phacoemulsification (0.04%) (p=0.005 and p<0.0001). DMD was more common among surgical trainees (0.17%) than consultants (0.07%) (p≤0.0001). After primary air descemetopexy, 78 (71%) out of the 110 patients had DM reattachment. The complications noted after descemetopexy include persistent DMD (21.8%), corneal decompensation (7.3%), appositional angle closure (18%), pupillary block with air (2.7%) and uveitis (2.7%). Age, sex and timing of intervention did not influence the reattachment rate. Fifteen patients underwent repeat air descemetopexy for persistent DMD among whom nine (60%) had successful reattachment. Almost 75% of patients had vision better than 6/18 1 month after anatomically successful descemetopexy. CONCLUSION Air descemetopexy is a safe and efficient modality of treatment of DMD and should be tried even in patients with severe DMD before planning a major surgery like endothelial keratoplasty.
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Affiliation(s)
- Annamalai Odayappan
- Department of General Ophthalmology, Aravind Eye Hospital, Pondicherry, India
| | | | | | | | - Sivagami Nachiappan
- Department of General Ophthalmology, Aravind Eye Hospital, Madurai, Tamil Nadu, India
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Abstract
PURPOSE OF REVIEW The review updates the mechanisms, clinical presentations, diagnoses, and managements of Descemet membrane detachment during cataract surgery. RECENT FINDINGS The advent of new imaging techniques such as anterior segment optical coherence tomography and better comprehension of the clinical and pathological aspects of detachment have improved the diagnosis and treatment of this complication to the extent that the first algorithms and protocols have been proposed. SUMMARY Though infrequent, Descemet membrane detachment is a complication of intraocular surgery, including cataract surgery and phacoemulsification. Since the first systematic description and classification in the literature by Samuels in 1928 and its characterization as a potential sight-threatening condition by Scheie in 1964, plenty of retrospective and anecdotal evidence contribute to uncertainty and debate. The main controversy still lies in the choice between conservative treatment in hopes of spontaneaous reattachment and surgical treatment in a timely manner to maximize visual recovery.
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Singh A, Vanathi M, Sahu S, Devi S. Intraoperative OCT assisted descemetopexy with stromal vent incisions and intracameral gas injection for case of non-resolving Descemet's membrane detachment. BMJ Case Rep 2017; 2017:bcr-2016-217268. [PMID: 28062421 DOI: 10.1136/bcr-2016-217268] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Descemet's membrane detachment (DMD) though uncommon in the present day scenario of advancing surgical techniques is a significant complication that requires prompt diagnosis and management. A middle-aged man presented to our hospital with poor gain of vision following cataract surgery. There was significant corneal oedema with DMD which was confirmed on anterior segment optical coherence tomography. We describe a modified continuous intraoperative-guided approach for the management of DMD in cases with oedematous hazy corneas. The aim of this technique is to allow early reattachment of Descemet's membrane in chronic cases where fluid pockets prevent reattachment of the posterior layer of cornea. Our technique involves the use of full thickness stromal vent incisions in the paracentral cornea along with intracameral isoexpansile concentration of gas for the successful settlement of the detached Descemet's membrane.
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Affiliation(s)
- Archita Singh
- Dr RP Centre for Ophthalmic Sciences, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Murugesan Vanathi
- Dr RP Centre for Ophthalmic Sciences, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Suman Sahu
- Dr RP Centre for Ophthalmic Sciences, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Saranya Devi
- Dr RP Centre for Ophthalmic Sciences, All India Institute of Medical Sciences (AIIMS), New Delhi, India
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Descemet’s Membrane Detachment with Schisis Induced by Phacoemulsification. Optom Vis Sci 2016; 93:1562-1566. [DOI: 10.1097/opx.0000000000000993] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Sun MT, Wood M, Chan W, Casson R. Pressures generated during corneal wound hydration. J Cataract Refract Surg 2016; 42:1383-1384. [PMID: 27697259 DOI: 10.1016/j.jcrs.2016.07.026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2016] [Accepted: 07/20/2016] [Indexed: 11/29/2022]
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Sharifipour F, Nassiri S, Idan A. Descemet's Membrane Detachment Management Following Trabeculectomy. J Ophthalmic Vis Res 2016; 11:323-5. [PMID: 27621793 PMCID: PMC5000538 DOI: 10.4103/2008-322x.188403] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Purpose: To present a case of total Descemet's membrane detachment (DMD) after trabeculectomy and its surgical management. Case Report: A 68-year-old woman presented with large DMD and corneal edema one day after trabeculectomy. Intracameral air injection on day 3 was not effective. Choroidal effusion complicated the clinical picture with Descemet's membrane (DM) touching the lens. Choroidal tap with air injection on day 6 resulted in DM attachment and totally clear cornea on the next day. However, on day 12 the same scenario was repeated with choroidal effusion, shallow anterior chamber (AC), and DM touching the lens. The third surgery included transconjunctival closure of the scleral flap with 10/0 nylon sutures, choroidal tap, and intracameral injection of 20% sulfur hexafluoride. After the third surgery, DM remained attached with clear cornea. Suture removal and needling bleb revision preserved bleb function. Lens opacity progressed, and the patient underwent uneventful cataract surgery 4 months later. Conclusion: Scleral flap closure using transconjunctival sutures can be used for DMD after trabeculectomy to make the eye a closed system. Surgical drainage of choroidal effusions should be considered to increase the AC depth.
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Affiliation(s)
- Farideh Sharifipour
- Department of Ophthalmology, Imam Khomeini Hospital, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Saman Nassiri
- Department of Ophthalmology, Imam Khomeini Hospital, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Aida Idan
- School of Medicine, Iran University of Medical Sciences, Tehran, Iran
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Garg J, Mathur U, Acharya MC, Chauhan L. Outcomes of Descemetopexy with Isoexpansile Perfluoropropane after Cataract Surgery. J Ophthalmic Vis Res 2016; 11:168-73. [PMID: 27413497 PMCID: PMC4926564 DOI: 10.4103/2008-322x.183932] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Purpose: To report the indications, anatomical outcomes, functional outcomes and limitations of descemetopexy with intracameral injection of isoexpansile perfluoropropane (14% C3F8) in eyes with Descemet's membrane (DM) detachment after cataract surgery. Methods: This retrospective non-comparative interventional case series included 67 eyes of 67 patients who underwent descemetopexy at a tertiary eye hospital. The procedure consisted of descemet's membrane reattachment by injecting isoexpansile perfluoropropane (14% C3F8)intracamerally. Outcome measures were reattachment of DM, improvement in visual acuity, resolution of corneal edema, causes for failure of DM reattachment and complications. Results: Sixty-seven eyes of 74 patients were analyzed. Phacoemulsification (56.71%) had the highest DM detachment as compared to manual SICS in 19 (28.36%) and ECCE in 10 (14.93%) eyes. Descemetopexy with 14% C3F8 resulted in anatomical reattachment of DM in 71.64% and functional improvement in visual acuity in 74.63% of treated eyes. The location and the extent of DM detachment did not influence DM reattachment. Complete reattachment of DM occurred in all 26 eyes (100%) with planar type detachments, whereas with non-planar type detachments only 22 eyes (53.7%) achieved complete reattachment. Conclusion: Descemetopexy with isoexpansile perfluoropropane offers good surgical outcomes regarding visual acuity and resolution of corneal edema.
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Affiliation(s)
- Jyoti Garg
- Department of Ophthalmology, Dr. Shroff's Charity Eye Hospital, New Delhi, India
| | - Umang Mathur
- Department of Ophthalmology, Dr. Shroff's Charity Eye Hospital, New Delhi, India
| | | | - Lokesh Chauhan
- Department of Ophthalmology, Dr. Shroff's Charity Eye Hospital, New Delhi, India
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Height-, extent-, length-, and pupil-based (HELP) algorithm to manage post-phacoemulsification Descemet membrane detachment. J Cataract Refract Surg 2016; 41:1945-53. [PMID: 26603403 DOI: 10.1016/j.jcrs.2015.01.020] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2014] [Revised: 12/11/2014] [Accepted: 01/06/2015] [Indexed: 11/17/2022]
Abstract
PURPOSE To analyze the functional and anatomic outcomes of management of Descemet membrane detachment after phacoemulsification using a protocol based on the detachment's height, extent, and chord length and its relation to the pupil. SETTING Dr. Agarwal's Eye Hospital and Eye Research Centre, Chennai, India. DESIGN Prospective comparative case series. METHODS Eyes with post-phacoemulsification Descemet membrane detachment were managed surgically or medically based on the detachment's height, extent, length (chord), and relation to the pupil (HELP protocol). Central corneal thickness (CCT), chord length, and detachment height were determined by anterior segment optical coherence tomography (AS-OCT) (Visante). RESULTS Of 161 eyes, 96 were treated surgically (Group 1) and 65 medically (Group 2). The mean length and mean height of Descemet membrane detachment were 2.4 mm ± 1.4 (SD) and 266 ± 189.8 μm, respectively, in Group 1 and 1.03 ± 0.4 mm and 153.3 ± 60.8 μm, respectively, in Group 2. The complete reattachment rate was 95.8% in Group 1 and 96.9% in Group 2. The corrected distance visual acuity (CDVA) was 20/40 or better in 83.3% of eyes in Group 1 and 92.3% of eyes in Group 2. No eye lost CDVA as a result of a Descemet membrane scar in the central 5.0 mm of the cornea. The AS-OCT allowed visualization of the detachment in all eyes with a CCT of more than 800 μm. There was no difference in the final CDVA between Group 1 and Group 2. CONCLUSIONS The AS-OCT-based algorithm was effective for managing post-surgical Descemet membrane detachment in eyes with dense corneal edema. Early surgical intervention for detachments in the central cornea can reduce scarring-induced visual loss. FINANCIAL DISCLOSURE No author has a financial or proprietary interest in any material or method mentioned.
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Incision-Site Descemet Membrane Detachment During and After Phacoemulsification: Risk Factors and Management. Eye Contact Lens 2016; 41:273-6. [PMID: 26322816 DOI: 10.1097/icl.0000000000000120] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To evaluate the occurrence of localized incision-site Descemet membrane detachment (DMD) during and after phacoemulsification and to study its relationship with phacoemulsification parameters. METHODS Forty-three, consecutive uneventful cases of phacoemulsification through 2.8-mm clear corneal incision were included in this prospective study. Preoperatively, the grade of cataract was assessed. The phacoemulsification parameters noted were phacoemulsification time, aspiration time, cumulative dissipated energy (CDE), ultrasound time, and total fluid volume. Anterior segment optical coherence tomography (AS-OCT) was performed on postoperative days 1 and 7 to study the course of the incision-site DMD. RESULTS Fourteen of 43 cases (32%) showed localized incision-site DMD either intraoperatively or on AS-OCT on the first postoperative day. Of these, nine cases were detected intraoperatively, and six cases were detected on AS-OCT on the first postoperative day. All cases were of planar type and resolved spontaneously. A single case showed a concurrent DMD involving central cornea, which resolved without any surgical intervention. The occurrence of DMD was significantly higher in those with the total ultrasound time greater than 60 sec (P=0.038) (odds ratio: 7.639). The CDE was higher in cases with DMD; however, the result was not statistically significant (P=0.062). Torsional equivalent in level-3, total torsional time, equivalent torsional time, aspiration time, and the total fluid volume were comparable (P>0.05) between cases with and without incision-site DMD. CONCLUSION Postphacoemulsification incision-site DMD may occur in up to one third of cases and is associated with increase in the total ultrasound time.
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Agraval U, Mantry S, Ramaesh K. Inadvertent Detachment of Descemet Membrane and Spontaneous Reattachment Following Cataract Surgery: An Anterior Segment Optical Coherence Tomography (AS OCT) Study. Semin Ophthalmol 2016; 32:529-531. [PMID: 27141975 DOI: 10.3109/08820538.2015.1123735] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Corneal oedema following cataract surgery during the immediate postoperative period is a common clinical problem, often due to endothelial injury due to multi-factorial mechanisms. Descemet's membrane detachment (DMD) is an underrecognized cause of postoperative corneal oedema. The understanding of the pathogenic mechanisms of DMD is still evolving. We report a case of DMD in a 64-year-old female presenting with immediate postoperative corneal oedema, diagnosed and monitored using anterior segment optical coherence tomography (AS OCT). Various mechanisms have been proposed for surgically induced DMD. We believe that hydration of surgical wounds at the end of surgery can inadvertently cause DMD, if DMD has not been recognized previously. Surgeons should be alert to this cause of DMD when hydrating surgical wounds.
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Affiliation(s)
- Umiya Agraval
- a Tennent Institute of Ophthalmology, Gartnavel General Hospital , Glasgow , UK
| | - Sanjay Mantry
- a Tennent Institute of Ophthalmology, Gartnavel General Hospital , Glasgow , UK
| | - Kanna Ramaesh
- a Tennent Institute of Ophthalmology, Gartnavel General Hospital , Glasgow , UK
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Bhatia HK, Gupta R. Delayed-onset descemet membrane detachment after uneventful cataract surgery treated by corneal venting incision with air tamponade: a case report. BMC Ophthalmol 2016; 16:35. [PMID: 27044281 PMCID: PMC4820919 DOI: 10.1186/s12886-016-0212-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2015] [Accepted: 03/29/2016] [Indexed: 11/16/2022] Open
Abstract
Background Descemet membrane detachment (DMD) is a significant complication noted during or early after cataract surgery. Review of literature revealed a few cases of delayed-onset DMD with presentation ranging from weeks to months after cataract surgery but most of them were treated with pneumatic descemetopexy and a few ended in penetrating keratoplasty. We report this case, to highlight the usefulness of corneal venting incision with air tamponade in late-onset DMD cases not responding to pneumatic descemetopexy. Case presentation A retrospective case review of a 66 year old male who presented with diminution of vision in right eye 17 days after uneventful cataract surgery was done. Visual acuity in this eye was 20/200 at presentation. DMD was noted 3 days later (approximately 3 weeks post-operatively) and Anterior Segment Optical Coherence Tomography & Scheimpflug imaging were done in view of diffuse corneal edema. Pneumatic descemetopexy was attempted thrice (twice with SF6, once with air) over a week’s span with limited success at re-attaching the DM. Finally, corneal venting incision with air tamponade was done resulting in egress of supra-descemet’s fluid and DM appeared apposed to stroma. Bandage contact lens (BCL) was applied at the end of the procedure. DM was seen attached the next day. Corneal edema cleared completely in 1 week. Best corrected visual acuity (BCVA) at 6 weeks follow-up was 20/30. Conclusion Delayed-onset DMD should be considered as a differential diagnosis in cases with late-onset corneal edema post-cataract surgery. Anterior segment Optical Coherence Tomography (AS-OCT) and Scheimpflug Imaging are useful tools in cases with dense corneal edema. Corneal venting incision with air tamponade is an option in cases where methods like pneumatic descemetopexy fail.
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Affiliation(s)
| | - Rakesh Gupta
- Shreya Eye Centre, D-163, Surajmal Vihar, Delhi, India
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Abstract
OBJECTIVE To report a case of unilateral spontaneous descemet membrane rupture associated with megalophthalmos. METHODS A case report of a 23-year-old woman with blurred vision of the right eye for 6 months due to spontaneous descemet membrane rupture associated with megalophthalmos is described. Slit-lamp examination demonstrated corneal edema and suggestion of a descemet membrane rupture in the right eye. RESULTS Anterior segment optical coherence tomography verified the presence of a ruptured descemet membrane separated from the nasal posterior cornea along with corneal edema and intraepithelial cystic lesions. With A-scan ultrasonography, axial lengths were 32 and 28 mm in OD and OS, respectively. Indirect gonioscopy demonstrated a wide iridocorneal angle and a ciliary body band, bilaterally. Corneal pachymetry measurements were performed with Pentacam HR Scheimpflug topography which measured the central corneal thickness 360 μ in OD and 300 μ in OS. CONCLUSIONS Megalophthalmos and spontaneous descemet membrane rupture are rare conditions. To the best literature knowledge, this is the first report of descemet membrane rupture in megalophthalmos.
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Wound Integrity of 2.0 mm Transconjunctival Single-Plane Sclerocorneal Incision: A Comparison between a Motorized Injector with/without Pause Time and a Manual Injector. J Ophthalmol 2016; 2016:8129298. [PMID: 26989502 PMCID: PMC4773554 DOI: 10.1155/2016/8129298] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2015] [Accepted: 01/26/2016] [Indexed: 12/02/2022] Open
Abstract
Purpose. To compare the final incision size and wound structure after the intraocular lens implantation from 2.0 mm transconjunctival single-plane sclerocorneal incision (TSSI) between the use of a motorized injector at first speed and the use of a manual injector. Methods. Patients were divided into three groups as follows: Group A, a manual injector, Group B, a motorized injector with 0.5 s pause time, and Group C, a motorized injector without pause time. The change in incision size and anterior segment optical coherence tomography findings of the wound structure were analyzed. Results. 110 eyes were enrolled (Group A: 40, Group B: 30, and Group C: 40). The averaged change in incision size (mm) was 0.08, 0.01, and 0.03 in Groups A, B, and C, respectively (p < 0.001). The incision enlargement in Group A was statistically larger compared with other groups (p < 0.01). Descemet's membrane detachments were seen in 26, 9, and 27 eyes one day after the surgery in Groups A, B, and C, respectively (p = 0.001). The rate of Descemet's membrane detachment in Group B was significantly lower than other groups (p < 0.01). Conclusions. The use of a motorized injector by fastest setting with 0.5 s pause time is the best for less wound damage in 2.0 mm TSSI.
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Wang SW, Tseng SH. Occult Descemet's membrane detachment after phacoemulsification surgery mimicking pseudophakic bullous keratopathy. Taiwan J Ophthalmol 2015; 5:136-139. [PMID: 29018686 PMCID: PMC5602711 DOI: 10.1016/j.tjo.2015.04.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2014] [Revised: 03/31/2015] [Accepted: 04/14/2015] [Indexed: 12/03/2022] Open
Abstract
We herein report two cases of occult Descemet's membrane detachment (DMD) after phacoemulsification surgery, which initially presented as persistent corneal edema and had been considered as pseudophakic bullous keratopathy. The patients were thus scheduled to receive corneal transplantation. For Case 1, DMD was incidentally detected by slit-lamp examination 2 months postoperatively, only when part of the cornea became clearer. For Case 2, anterior segment optical coherence tomography demonstrated extensive DMD, which had lasted 5 months after the operation. DMDs in both patients had been successfully attached after descemetopexy. Occult DMD should be suspected in patients with persistent severe corneal edema after phacoemulsification surgery. Corneal transplantation may be avoided by timely diagnosis and treatment of DMD.
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Affiliation(s)
- Shih-Wen Wang
- Department of Ophthalmology, National Cheng-Kung University Hospital, College of Medicine, National Cheng-Kung University, Tainan, Taiwan
| | - Sung-Huei Tseng
- Department of Ophthalmology, National Cheng-Kung University Hospital, College of Medicine, National Cheng-Kung University, Tainan, Taiwan
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A new clinico-tomographic classification and management algorithm for Descemet's membrane detachment. Cont Lens Anterior Eye 2015; 38:327-33. [PMID: 25936569 DOI: 10.1016/j.clae.2015.03.012] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2014] [Revised: 03/22/2015] [Accepted: 03/28/2015] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To propose a new clinico-tomographic classification of Descemet's detachment (DD). METHODS Interventional case series of 35 eyes with DD were clinico-tomographically classified as: (1)Rhegmatogenous DD (RDD)-lax, free floating DM secondary to DM tear/hole/dialysis; ASOCT showing undulating linear signal with total length equalling overlying stromal arc length. (2) Tractional DD (TDD)-foreshortened, taut DM with tractional/fibrotic component; ASOCT showing detached DM chord length less than overlying stromal arc length. (3) Bullous DD (BDD)-bulge of DM into AC in absence of DM break or needle puncture break too small to allow egress of contents; ASOCT showing convex signal. (4) Complex DD (CDD)-Complex variants and combinations seen clinically and on ASOCT. RESULTS RDD was most common (n=23), 19 were RDD with tear (post-surgical) treated by observation(n=3)/pneumodescemetopexy(n=16), 2 were RDD with hole due to inadvertent DM perforation in deep anterior lamellar keratoplasty treated by pneumodescemetopexy and fibrin glue, 2 were RDD with dialysis post-Descemetorhexis in Descemet's Membrane Endothelial Keratoplasty, not requiring treatment. TDD (n=4) was treated by relaxing Descemetotomy (n=3) or EK (n=1, poor endothelium); BDD (n=3) with two improving spontaneously; CDD (n=5) treated by refloatation with air (n=3)/EK (n=1)/penetrating keratoplasty (n=1). CONCLUSION Treatment and prognosis of DD varies based on etio-morphology. This classification allows systematic approach for diagnosis, management and prognostication.
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Abstract
PURPOSE Descemet membrane detachment (DMD) is uncommon. It most frequently occurs as a complication of intraocular surgery. The aim of this study was to report a case of DMD after neodymium-doped yttrium aluminum garnet (Nd:YAG) laser capsulotomy in a patient with Fuchs dystrophy. METHODS We describe the case of an 89-year-old man suffering from Fuchs dystrophy, who underwent cataract surgery on his left eye. Three years later, the patient presented with posterior capsule opacification, which was treated using Nd:YAG laser capsulotomy. The day after the procedure, the patient came back for emergency treatment because of an acute reduction in his vision caused by a DMD. RESULTS Fifteen days after an initial treatment involving the injection of air into the anterior chamber coupled with ocular paracentesis, clinical examination revealed a significant improvement in visual acuity, reduction in corneal edema, and reattachment of Descemet membrane. These findings were confirmed using anterior segment optical coherence tomography. CONCLUSIONS To our knowledge, this is the first reported case of DMD after Nd:YAG laser capsulotomy.
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Kim JJ, Kim HK. Descemet membrane stripping endothelial keratoplasty for Descemet membrane detachment following phacoemulsification. Can J Ophthalmol 2015; 50:73-6. [DOI: 10.1016/j.jcjo.2014.10.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2014] [Revised: 10/17/2014] [Accepted: 10/28/2014] [Indexed: 11/29/2022]
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Matas Riera M, Donaldson D, Priestnall SL. Descemet's membrane detachment in horses; case series and literature review. Vet Ophthalmol 2014; 18:357-63. [DOI: 10.1111/vop.12199] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Màrian Matas Riera
- Ophthalmology Service; Royal Veterinary College; Hawkshead Lane North Mymms AL97TA London UK
| | - David Donaldson
- Unit of Comparative Ophthalmology; Animal Health Trust; Lanwades Park Newmarket CB87UU UK
| | - Simon Lawrence Priestnall
- Dept of Pathology and Pathogen Biology; Royal Veterinary College; Hawkshead Lane, North Mymms AL97TA London UK
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Comparison of sulfur hexafluoride and air for donor attachment in Descemet stripping endothelial keratoplasty in patients with pseudophakic bullous keratopathy. Cornea 2014; 33:219-22. [PMID: 24452211 DOI: 10.1097/ico.0000000000000049] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE The aim of this study was to evaluate the clinical efficacy and safety of sulfur hexafluoride (SF6) as a tamponading agent after donor placement during Descemet stripping endothelial keratoplasty (DSEK) surgery and to compare the outcomes with those of air. METHODS Forty-four eyes of 44 consecutive patients who underwent DSEK were included in the study. Air was used in 22 eyes of 22 patients (air group), and SF6 was used in 22 eyes of 22 patients (SF6 group) to attach the donor lenticule. The complications, corrected visual acuity (CVA), and the endothelial cell density (ECD) results were compared between these 2 groups. RESULTS Six eyes had graft dislocation in the air group that underwent successful rebubbling on postoperative day 1. There was no graft dislocation in the SF6 group. There was no other complication observed in both the groups. The mean increase in the CVA was 1.09 ± 0.36 logarithm of the minimum angle of resolution in the air group, whereas it was 0.80 ± 0.57 logarithm of the minimum angle of resolution in the SF6 group. The mean increase in the CVA was not statistically different between the 2 groups (P = 0.060). Compared with the mean ECD in donor grafts, the mean decrease in the ECD was 222 ± 86 (44%) cells per square millimeter in the air group and 178 ± 52 (39%) cells per square millimeter in the SF6 group at the 1-year follow-up. The mean decrease in the ECD was statistically significantly higher in the air group compared with that in the SF6 group (P = 0.049). CONCLUSIONS SF6 is comparable to air for attaching the donor graft as a tamponading agent in DSEK surgery.
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Datar S, Kelkar A, Jain AK, Kelkar J, Kelkar S, Gandhi P, Shah R, Kedia R. Repeat Descemetopexy after Descemet's Membrane Detachment following Phacoemulsification. Case Rep Ophthalmol 2014; 5:203-6. [PMID: 25126074 PMCID: PMC4130814 DOI: 10.1159/000365279] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Descemet's membrane detachment (DMD) is an uncommon condition with a wide range of possible etiologies. Probably the commonest cause is a localized detachment occurring after cataract extraction surgery. Descemetopexy gives good anatomic attachment rates and visual outcomes and has become the standard treatment for DMD. However, in cases with failed initial descemetopexy, the next step in the management of such cases remains unclear. Before initiating a complex surgical procedure like keratoplasty, which requires good postoperative care and regular follow-ups, repeat descemetopexy with a long-term tamponade using 14% C3F8 gas for recurrent DMD is definitely a worthwhile attempt.
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Affiliation(s)
- Sameer Datar
- National Institute of Ophthalmology, Pune, India
| | | | | | - Jai Kelkar
- National Institute of Ophthalmology, Pune, India
| | | | | | - Rachna Shah
- National Institute of Ophthalmology, Pune, India
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Comparison of morphologic features of clear corneal incisions created with a femtosecond laser or a keratome. J Cataract Refract Surg 2014; 40:521-30. [DOI: 10.1016/j.jcrs.2013.11.028] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2013] [Revised: 11/12/2013] [Accepted: 11/13/2013] [Indexed: 11/24/2022]
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Jain R, Mohan N. Outcomes of repeat descemetopexy in post-cataract surgery descemet membrane detachment. Am J Ophthalmol 2014; 157:571-5.e1-2. [PMID: 24246573 DOI: 10.1016/j.ajo.2013.11.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2013] [Revised: 11/06/2013] [Accepted: 11/08/2013] [Indexed: 10/26/2022]
Abstract
PURPOSE To assess the outcomes of repeat descemetopexy in post-cataract surgery Descemet membrane detachment. DESIGN Retrospective interventional case series. METHODS This multicenter, institutional study done between January 2007 and July 2013 included 13 eyes of 13 patients who underwent repeat descemetopexy after a failed initial procedure in post-cataract surgery Descemet membrane detachment. Patients without a minimum follow-up of 1 month were excluded. They underwent repeat descemetopexy with either 100% air or isoexpansile mixture of 14% C3F8. At 1 month, final status of Descemet membrane, final best-corrected visual acuity (BCVA), and incidence of postsurgical complications were noted. RESULTS Mean age was 63.7 ± 6.6 years; male-to-female ratio, 8:5. Descemet membrane detachment involved the visual axis in all cases. Mean interval between 2 interventions was 5.1 ± 3.1 days. Same gas was used in 9 of 13 patients (air, 4; C3F8, 5). Air was used earlier and C3F8 later in 4 patients. At 1 month, 12 of 13 patients had an attached Descemet membrane and improved mean logMAR BCVA (P = .0036). One case developed postoperative pupillary block and 1 case required endothelial transplantation. CONCLUSION Repeat descemetopexy for post-cataract surgery Descemet membrane detachment gives good anatomic and visual results and is definitely a worthwhile attempt before a complex surgical procedure like keratoplasty is offered.
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Abstract
PURPOSE The aim of this study was to report a case of a central Descemet membrane detachment after heavy silicone oil removal from the anterior chamber. METHODS This is a case report of a patient operated with scleral buckling and heavy silicone oil implantation for recurrent retinal detachment. In the patient's follow-up examination, silicone oil was found to completely fill the anterior chamber. He underwent silicone extraction through a paracentesis from the anterior chamber. Immediately after the surgery, a central Descemet membrane detachment combined with corneal edema was identified on slit-lamp examination, and confirmed by anterior segment optical coherence tomography. The detached Descemet membrane was tamponaded successfully with the air bubble injection technique. RESULTS Four days later, the patient's cornea appeared to be clear, and the Descemet membrane was found to be attached to the corneal stroma with no presence of silicone oil in the anterior chamber. CONCLUSIONS Descemet membrane detachment is a possible and rare complication that occurs after heavy silicone oil removal from the anterior chamber.
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