1. Andrés Suárez-Campo, María López-Valladares
Abstract ID: WGCSUB-1775
Surgical management of hemorrhagic Descemet’s membrane detachment after deep sclerectomy
Andrés Suárez-Campo, María López-Valladares
Glaucoma Unit. Department of Ophthalmology. University Hospital Complex of Santiago de Compostela. Santiago de Compostela. Spain
PURPOSE:
To describe a case of hemorrhagic Descemet's membrane detachment following deep sclerectomy and to discuss its surgical management.
METHODS:
Interventional case report.
CASE REPORT:
A 74-year-old woman suffering with chronic open-angle glaucoma, dry eye syndrome and intolerance to glaucoma medications underwent an uncomplicated deep sclerectomy combined with phacoemulsification and intraocular lens implantation.
One week after the surgery, the patient presented with a hemorrhagic Descemet's membrane detachment (DMD) in the upper quadrants (IOP 14 mmHg) (Fig. 1A). Two weeks after the surgery, the hemorrhagic detachment did not show any change (Fig.1B). The anterior segment OCT (Zeiss Cirrus HD-OCT 4000) showed a Descemet’s detachment with a hyperreflective homogeneus content (Fig.2). Since the hemorrhage showed limited improvement after 4 weeks (Fig. 1C), we decided to perform a surgical evacuation. Under topical anesthesia and after air injection into the anterior chamber, we performed a 2 mm partial corneal thickness incision near the limbus, in the Descemet’s membrane detachment area. After partial draining of the hemorrhage through this incision, 15% sulphur hexafluoride (SF6) was injected in the anterior chamber. 24-hours after the surgical drainage, we observed a residual DMD in the upper nasal quadrants (Fig. 2A). During the following weeks, slowly reabsorption of the blood was noticed with progressive increase of hemosiderin deposition at the lower area, and complete resolution of the DMD (Fig. 2B and 2C).
The bleb was not functionally impaired during the postoperative period, and intraocular pressure remained under 13 mmHg without medication. 15 months after surgical drainage, the Descemet's membrane remained completely reattached, and a small area of corneal blood staining persisted in the pre-Descemet space (Fig. 2D), outside the visual axis, and the visual acuity without correction was 20/30. A B C
Figure 2: 2 weeks after surgery: Anterior segment OCT.
Figure 1: Hemorrhagic Descemet’s membrane detachment evolution. At presentation, one week after surgery (A). 2 weeks after surgery (B). 4 weeks after surgery (C): limited central clearing of hemorrhage. A B C D
Figure 2: Hemorrhagic Descemet’s membrane detachment (DMD) evolution after partial surgical evacuation, showing gradual blood reabsorption. 24-hours after surgery (A): residual hemorrhagic DMD. 1 week after surgery (B). 10 weeks after surgery (C): blood traces and hemosiderin deposition in pre-Descemet space. 15 months after surgery (D): small area of corneal blood staining.
CONCLUSIONS:
Hemorrhagic Descemet's membrane detachment is a rare complication after deep sclerectomy. Surgical evacuation through a partial corneal incision prevents further complications, as corneal scarring and vision loss.
REFERENCES:
1. Kozobolis VP, Christodoulakis EV, Siganos CS, Pallidaris IG. Hemorrhagic Descemet’s membrane detachment as a complication of deep sclerectomy: a case report. J Glaucoma 2001;
2. Rekas M, Petz K, Wierzbowska J, Byszewska A, Jünemann A. Evacuating a pre-Descemet hematoma through a clear corneal incision during a canaloplasty procedure. J Cataract Refract Surg 2014; 40:
3. Alobeidan SA, Almobarak FA. Incidence and management of haemorrhagic Descemet membrane detachment in canaloplasty and phacocanaloplasty. Acta Ophthalmol 2016;e298-e304
Financial disclosure: The authors have no competing financial interests to declare