APPROACH TO THE DESCEMET MEMBRANE DETACHMENT THAT IS NOTICED LATE PERİOD AFTER CATARACT SURGERY

Yıl 2022, Cilt: 23 Sayı: 3, 350 - 353, 18.07.2022

Erdinç Bozkurt , Ersin Muhafız

https://doi.org/10.18229/kocatepetip.701340

Öz

We aimed to present the differential diagnosis and treatment of Descemet membrane detachment (DMD) in a patient with acute corneal edema after phacoemulsification surgery. A 52-year-old female patient presented to our clinic with acute corneal edema and visual impairment secondary to DMD, which was noticed on the postoperative 16th day after routine phacoemulsification surgery in the left eye. On the 16th day, visual acuity of the case was; 0.8 in the right eye and from 50 cm in the left eye at the level of counting finger. In biomicroscopic examination nuclear sclerosis in the right eye, diffuse corneal edema except the upper temporal region in the left eye was followed. Intraocular pressures were normal in both eyes. On fundus examination, the right eye was normal and the left eye was normal ultrasonographically like the right eye although cannot be evaluated clearly. Anterior segment optical cohorens tomography (ASOCT) was performed with suspicion of DMD. ASOCT images showed a hyperreflective band that was forming a second anterior chamber under corneal epithelial and stromal edema. The patient was being diagnosed with DMD and corneal edema related with this and perfluoropropane (C3F8) injection was made into the anterior chamber. On the third day following the injection, the cornea was transparent except for the paracentral descemet wrinkles, there was gas appearance in the anterior chamber and visual acuity increased to 0.2 level according to snellen. This case shows us that intracameral gas injections can be an effective treatment modality in DMDs exceeding two weeks.

Anahtar Kelimeler

Corneal edema, Descemet membrane detachment, Perflorapropane.

KATARAKT AMELİYATI SONRASI GEÇ DÖNEMDE FARKEDİLEN DESCEMET MEMBRAN DEKOLMANINA YAKLAŞIM

Öz

Fakoemülsifikasyon cerrahisi sonrası akut kornea ödemi gelişen bir katarakt olgusunda, Descemet membran dekolmanının (DMD) ayırıcı tanı ve tedavisini sunmayı amaçladık. 52 yaşındaki bayan hasta, sol gözde rutin fakoemülsifikasyon cerrahisi sonrası postoperatif 16. gün farkedilen DMD’ye sekonder akut kornea ödemi ve görme bozukluğu şikayeti ile kiniğe başvuruyor. Olgunun postoperatif 16. gün kontrolünde görme keskinliği sağ gözde 0.8, sol gözde ise 50cm’den parmak sayma düzeyinde olduğu görüldü. Biyomikroskobik muayenede sağ gözde nükleer skleroz, sol gözde üst temporal bölge hariç yaygın kornea ödemi izlenmekteydi. Göz içi basınçları her iki gözde normaldi. Fundus muayenesinde sağ doğal, solda net olarak değerlendirilememekle beraber göz dibi ultrasonografik olarak normaldi. DMD’den şüphelenilerek anterior segment optik kohorens tomografi (ASOCT) çekildi. ASOCT görüntülerinde korneal epitelyal ve stromal ödem altında ikinci bir ön kamara oluşturan hiperreflektif bant fark edilmiştir. Hastaya DMD ve buna bağlı kornea ödemi tanısı konarak, ön kamaraya perfloropropan (C3F8) enjeksiyonu yapıldı. Enjeksiyonu takip eden 3. günde, parasantral descemet kırışıklıkları dışında kornea saydamdı, ön kamarada superiorda gaz mevcut idi ve görme keskinliği 0,2 düzeyine çıkmıştı. Bu olgu bize 14 günü aşan DMD’lerde intrakamaral gaz enjeksiyonlarının etkili bir tedavi yöntemi olabileceğini göstermektedir.

Anahtar Kelimeler

Korneal ödem, Descemet membran dekolmanı, Perflorapropan.

Kaynakça

• 1. Benatti CA, Tsao JZ, Afshari NA. Descemet membrane detachment during cataract surgery: etiology and management. Curr Opin Ophthalmol. 2017;28(1):35-41.
• 2. Orucoglu F, Aksu A. Complex Descemet’s membrane tears and detachment during phacoemulsification. J Ophthalmic Vis Res. 2015;10(1):81-3.
• 3. Ti SE, Chee SP, Tan DT, et al. Descemet membrane detachment after phacoemulsification surgery: risk factors and success of air bubble tamponade. Cornea. 2013; 32: 454- 9.
• 4. Datar S, Kelkar A, Jain AK, et al. Repeat descemetopexy after Descemet’s membrane detachment following phacoemulsification. Case Rep Ophthalmol. 2014;5(2):203-6.
• 5. Polat N, Ulucan PB. Nontraumatic Descemet membrane detachment with tear in osteogenesis imperfecta. Ophthalmol Ther. 2015;4(1):59-63.
• 6. Singhal D, Sahay P, Goel S, et al. Descemet membrane detachment. Surv Ophthalmol. 2020;65(3):279‐93.
• 7. Jacop S, Agarwal A, Chaudhry P, et al. A new clinico-tomographic classification and management algorithm for Descemet’s membrane detachment. Cont Lens Anterior Eye. 2015;38(5):327-33.
• 8. Marcon AS, Rapuano CJ, Jones MR, et al. Descemet’s membrane detachment after cataract surgery: management and outcome. Ophthalmology. 2002;109:2325-30.
• 9. Namrata S, Deepali S, Sreelakshmi PN, et al. Prafulla Kumar Maharana. Corneal edema after phacoemulsification. Indian J Ophthalmol. 2017; 65(12): 1381–89.
• 10. Coşar CB, Acar S. Penetran Keratoplasti Endikasyonları. Turkiye Klinikleri J Ophthalmol. 2005; 14: 162-6.
• 11. Cosar CB, Sridhar MS, Cohen EJ, et al. Indications for penetrating keratoplasty and associated procedures, 1996-2000. Cornea. 2002; 21: 148-51.
• 12. Steinert RF. Corneal Edema after Cataract Surgery, in Cataract Surgery: Technique, Complications, and Management, Third Edition. Philadelphia, Elsevier, WB Saunders, 2009;49: 595-602.
• 13. Menezo V, Choong YF, Hawksworth NR. Reattachment of extensive Descemet’s membrane detachment following uneventful phaco-emulsification surgery. Eye. 2002; 16: 786-8.
• 14. Selver OB, Eğrilmez S. Diagnosis and management of Descement’s mebrane detachment: a cause of corneal edema after cataract surgery. Turk J Ophthalmol. 2014;44(6):486- 90.
• 15. Kim T, Hasan SA. A new technique for repairing descemet's membrane detachments using intracameral gas injection. Arch Ophthalmol. 2002;120:181–3.