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PHOTO ESSAY
Year : 2020  |  Volume : 68  |  Issue : 5  |  Page : 906-907

Descemet detachment in a phakic patient


Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India

Date of Submission13-Apr-2019
Date of Acceptance06-Nov-2019
Date of Web Publication20-Apr-2020

Correspondence Address:
Prof. Namrata Sharma
Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi - 110 029
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijo.IJO_1864_19

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Keywords: Descemet detachment, Phakic, Healed keratitis


How to cite this article:
Beniwal A, Bafna RK, Sharma N. Descemet detachment in a phakic patient. Indian J Ophthalmol 2020;68:906-7

How to cite this URL:
Beniwal A, Bafna RK, Sharma N. Descemet detachment in a phakic patient. Indian J Ophthalmol [serial online] 2020 [cited 2020 Jun 4];68:906-7. Available from: http://www.ijo.in/text.asp?2020/68/5/906/282947



Descemet's membrane is product of synthesis and secretion of endothelial cell layer and is bound to it by hemidesmosome-binding complexes.[1] However, the association between Descemet membrane and stroma is much more labile. This interface has fibrillar bundles of collagen in corneal stroma with particular spatial arrangement. Type IV collagen is also present. Usually surgical trauma is the triggering factor in Descemet detachment. Fluid seeps in pre-Descemet space separating it from stroma. However, as the subsequent discussion will show, surgical trauma is not the only factor in Descemet detachment.

A 42-year-old female patient presented to OPD with complaint of black floater in left eye for 20 days. She had visual acuity of 20/125 both eyes. Intraocular pressure was 14 mm Hg on applanation tonometry. On examination, right eye had macular corneal opacity inferotemporally [Figure 1]a and [Figure 1]b. Lens was clear. Rest anterior segment was unremarkable. Left eye had more opacity than right eye and a Descemet membrane detachment was noticed inferonasally [Figure 2]a and [Figure 2]b Lens was clear and rest anterior segment was unremarkable. On fundus evaluation, both eyes of patient had cup-disc ratio of 0.4:1. There was peripapillary crescent and foveal reflex was dull. Patient had myopic fundus. In left eye, there was posterior vitreous detachment corresponding with her history of black floater. The finding of Descemet membrane detachment was confirmed on anterior segment optical coherence tomography [Figure 2]c. Both eyes showed scarring on anterior segment optical coherence tomography (ASOCT), [Figure 1]c and [Figure 2]c and right eye showed thinning in the area of opacity (pachymetry being 301 micrometer), whereas left eye was 543 micrometer thick. Confocal microscopy was done and altered endothelial pattern was noted [Figure 1]d and [Figure 2]d. Since the scarring was not in visual axis and the detachment was not causing any edema, no surgical intervention was done. A refraction was done and vision improved to 20/63 in both the eyes.
Figure 1: Slit lamp images of right eye showing macular corneal opacity nasally (a and b). ASOCT through opacity showing scarring and thinning (c). Confocal showing altered endothelial pattern (d)

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Figure 2: Slit lamp image of left eye showing macular opacity with Descemet detachment (a) detachment focused in higher magnification (arrow) (b). ASOCT showing cornea with normal pachymetry but scarring and descemet detachment (c). Confocal showing altered endothelial pattern (d)

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  Discussion Top


Descemet membrane can detach after surgical intervention. However, detachment in a virgin eye is rare. The Descemet detachment seen here could be due to keratitis and consequential stromal scarring. The Descemet could not conform to the shape of scarred stroma leading to separation. Hollumer et al. has reported hemorrhagic Descemet detachment following syphilitic interstitial keratitis.[2] Macpherson et al. has reported a case of spontaneous hemorrhagic descemet membrane detachment (DMD) in a patient on warfarin.[3] A case of reduplicated Descemet's membrane with partial Descemet detachment secondary to occult deep herpes simplex keratitis has been reported by Banik et al.[4] Descemet detachment has been reported after uncomplicated cataract surgery and that may have resulted from underlying endothelial disorder rather than surgery itself. Fang et al.[5] reported a case of bilateral Descemet detachment with documented preoperative anomalies of corneal endothelium.

Although surgical Descemet detachment is a known entity, noniatrogenic detachment of Descemet membrane is rare. In our case, possibly previous viral keratitis led to stromal scarring separating the Descemet as it could not conform to the altered shape. Possible weak attachment of Descemetwith posterior stroma aided in detachment. Insight regarding risk of Descemet detachment might be helpful to counsel patients undergoing surgery despite an uneventful surgery.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Yanoff M, Fine BS. Ocular Pathology. A Text and Atlas, Hagerstown, Md., 1975. p. 176.  Back to cited text no. 1
    
2.
Höllhumer R, Zairani Mz A, Watson S. Hemorrhagic descemet membrane detachment following syphilitic interstitial keratitis. Cornea 2016;35:1255-6.  Back to cited text no. 2
    
3.
Eide Macpherson JF, Slettedal JK, Drolsum L, Thilesen T. Spontaneous hemorrhagic Descemet membrane detachment causing pupillary block. Eur J Ophthalmol 2012;22:819-22.  Back to cited text no. 3
    
4.
Banik R, Novick LH, Smith RE, Chuck RS. Retrocorneal membrane with Descemet's detachment. Cornea 2001;20:763-4.  Back to cited text no. 4
    
5.
Fang JP, Amesur KB, Baratz KH. Preexisting endothelial abnormalities in bilateral postoperative Descemet membrane detachment. Arch Ophthalmol 2003;121:903-4.  Back to cited text no. 5
    


    Figures

  [Figure 1], [Figure 2]



 

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