Late-onset descemet membrane detachment and corneal decompensation after laser peripheral iridotomy: A case report

Descemet's membrane detachment after Nd:YAG laser iridotomy in a patient with pseudoexfoliation

Laser peripheral iridotomy is a relatively safe and an effective treatment for pupillary block. Descemet's membrane detachment (DMD) is an uncommon condition that occurs as a complication of intraocular surgery or after trauma. In this article, we report a case of DMD in a 71-year-old man after Neodymium:Yttrium-Aluminum-Garnet laser peripheral iridotomy in an eye with pseudoexfoliation. The shock waves formed during photodisruption may produce linear cracks at the level of Descemet's membrane; resulting in detachment. Hence, it is important to be aware of this rare complication especially in eyes with a shallow anterior chamber and predisposing factors like pseudoexfoliation.

Late-onset spontaneous Descemet's membrane detachment post penetrating keratoplasty in a patient with congenital glaucoma

A 27-year-old female presented with a sudden decrease of vision in the left eye (OS). Ocular history included advanced congenital glaucoma and previous (15 years) bilateral penetrating keratoplasty and cyclophotocoagulation (9 months) in the left eye. The patient had microcystic corneal edema and Descemet's membrane (DM) detachment; imaging confirmed the detachment with no detectable breaks. DM re-attachment was attempted with an intracameral air bubble tamponade. The edema improved 10 days postoperatively and the graft became clear. Late-onset DM detachment following keratoplasty can occur in patients with congenital glaucoma with no history of recent trauma or eye rubbing. The exact mechanism is unknown, but transscleral cyclophotocoagulation may have a causative role. Timely treatment with air injection results in successful anatomic outcomes.

Clinical, ultrasonographic, and histopathologic findings in seven horses with Descemet's membrane detachment: A case series

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.