Partial descemetorhexis for delayed Descemet membrane detachment following penetrating keratoplasty, suggestion of a pathomechanism
Purpose: to report a case of delayed Descemet membrane detachment (DMD) 45 years after penetrating keratoplasty (PK) for keratoconus and its management with a partial descemetorhexis after failed air/gas descemetopexy. A pathomechanism of DMD is proposed based on the anatomic appearance of the DMD a...
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2021-06-01
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doaj-8cda0d3c41394e43b0504be4b8ec3d882021-05-22T04:38:04ZengElsevierAmerican Journal of Ophthalmology Case Reports2451-99362021-06-0122101077Partial descemetorhexis for delayed Descemet membrane detachment following penetrating keratoplasty, suggestion of a pathomechanismSomar M. Hasan0Juliane Jakob-Girbig1Konstantinos Pateronis2Daniel Meller3Corresponding author. Department of Ophthalmology, Jena University Hospital, Am Klinikum 1, 07747, Jena, Germany.; Department of Ophthalmology, Jena University Hospital, GermanyDepartment of Ophthalmology, Jena University Hospital, GermanyDepartment of Ophthalmology, Jena University Hospital, GermanyDepartment of Ophthalmology, Jena University Hospital, GermanyPurpose: to report a case of delayed Descemet membrane detachment (DMD) 45 years after penetrating keratoplasty (PK) for keratoconus and its management with a partial descemetorhexis after failed air/gas descemetopexy. A pathomechanism of DMD is proposed based on the anatomic appearance of the DMD and the success of descemetorhexis. Observations: a 60-year old male presented with acute corneal edema of his left eye 45 years after successful PK for keratoconus. Anterior segment ocular coherence tomography (AS-OCT) revealed a wide area of DMD without a visible tear. Reattachment was tried using air and gas descemetopexy with only temporary success. A partial descemetorhexis was then performed just centrally to the graft-host interface and only in the detached area followed by injection of gas bubble. Complete reattachment of Descemet membrane (DM) on the 1st post-operative day was achieved. This anatomical success was maintained 3 months post-surgery and accompanied by decrease of central corneal thickness, however with uncomplete restoration of visual acuity. Conclusion: delayed DMD following KP for keratoconus should be differentiated from acute graft rejection. It could be a result of Descemet tear, but in some cases and despite careful observation of AS-OCT no tear could be seen. In such cases, a tractional detachment of DM might be the underlying pathomechanism and descemetorhexis could help manage it. This new surgical approach might help avoid a re-keratoplasty. Importance: This is the first case report describing success of partial descemetorhexis as a surgical management option for delayed DMD and suggesting a pathogenesis based on this success. This might help avoid re-keratoplasty as a management of this rare complication.http://www.sciencedirect.com/science/article/pii/S2451993621000864DescemetorhexisDescemetopexyKeratoplastyKeratoconusDelayed Descemet membrane detachment |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Somar M. Hasan Juliane Jakob-Girbig Konstantinos Pateronis Daniel Meller |
spellingShingle |
Somar M. Hasan Juliane Jakob-Girbig Konstantinos Pateronis Daniel Meller Partial descemetorhexis for delayed Descemet membrane detachment following penetrating keratoplasty, suggestion of a pathomechanism American Journal of Ophthalmology Case Reports Descemetorhexis Descemetopexy Keratoplasty Keratoconus Delayed Descemet membrane detachment |
author_facet |
Somar M. Hasan Juliane Jakob-Girbig Konstantinos Pateronis Daniel Meller |
author_sort |
Somar M. Hasan |
title |
Partial descemetorhexis for delayed Descemet membrane detachment following penetrating keratoplasty, suggestion of a pathomechanism |
title_short |
Partial descemetorhexis for delayed Descemet membrane detachment following penetrating keratoplasty, suggestion of a pathomechanism |
title_full |
Partial descemetorhexis for delayed Descemet membrane detachment following penetrating keratoplasty, suggestion of a pathomechanism |
title_fullStr |
Partial descemetorhexis for delayed Descemet membrane detachment following penetrating keratoplasty, suggestion of a pathomechanism |
title_full_unstemmed |
Partial descemetorhexis for delayed Descemet membrane detachment following penetrating keratoplasty, suggestion of a pathomechanism |
title_sort |
partial descemetorhexis for delayed descemet membrane detachment following penetrating keratoplasty, suggestion of a pathomechanism |
publisher |
Elsevier |
series |
American Journal of Ophthalmology Case Reports |
issn |
2451-9936 |
publishDate |
2021-06-01 |
description |
Purpose: to report a case of delayed Descemet membrane detachment (DMD) 45 years after penetrating keratoplasty (PK) for keratoconus and its management with a partial descemetorhexis after failed air/gas descemetopexy. A pathomechanism of DMD is proposed based on the anatomic appearance of the DMD and the success of descemetorhexis. Observations: a 60-year old male presented with acute corneal edema of his left eye 45 years after successful PK for keratoconus. Anterior segment ocular coherence tomography (AS-OCT) revealed a wide area of DMD without a visible tear. Reattachment was tried using air and gas descemetopexy with only temporary success. A partial descemetorhexis was then performed just centrally to the graft-host interface and only in the detached area followed by injection of gas bubble. Complete reattachment of Descemet membrane (DM) on the 1st post-operative day was achieved. This anatomical success was maintained 3 months post-surgery and accompanied by decrease of central corneal thickness, however with uncomplete restoration of visual acuity. Conclusion: delayed DMD following KP for keratoconus should be differentiated from acute graft rejection. It could be a result of Descemet tear, but in some cases and despite careful observation of AS-OCT no tear could be seen. In such cases, a tractional detachment of DM might be the underlying pathomechanism and descemetorhexis could help manage it. This new surgical approach might help avoid a re-keratoplasty. Importance: This is the first case report describing success of partial descemetorhexis as a surgical management option for delayed DMD and suggesting a pathogenesis based on this success. This might help avoid re-keratoplasty as a management of this rare complication. |
topic |
Descemetorhexis Descemetopexy Keratoplasty Keratoconus Delayed Descemet membrane detachment |
url |
http://www.sciencedirect.com/science/article/pii/S2451993621000864 |
work_keys_str_mv |
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