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Graefe's Archive for Clinical and Experimental Ophthalmology

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Open Access 08-09-2023 | Keratoplasty | Cornea

Surgical management of complicated Descemet’s membrane detachment in corneas without prior endothelial keratoplasty

Authors: Tim Berger, Berthold Seitz, Elias Flockerzi, Shady Suffo, Fidelis A. Flockerzi, Maximilian Berger, Nóra Szentmáry, Loay Daas

Published in: Graefe's Archive for Clinical and Experimental Ophthalmology | Issue 3/2024

Abstract

Purpose

To provide insights into morphologic and functional features of eyes with complicated Descemet's membrane detachment (DMD) and report clinical outcomes after surgical intervention.

Methods

Retrospective study of 18 eyes with complicated DMD between 2010 and 2022. Complicated DMD was defined if any of the following criteria applied: prior penetrating keratoplasty (PKP), corneal thinning, total DMD or persistent DMD after Air/Gas-Descemetopexy. Causes, surgical management, and clinical outcomes were analyzed. Scheimpflug tomography, anterior segment optical coherence tomography (AS-OCT) and histologic examination were performed to characterize corneas with DMD.

Results

Fourteen eyes with prior PKP developed spontaneous DMD after 24.2 ± 12.9 years (range = 18 months – 47 years, median = 25.7 years). Complicated DMD without prior PKP was associated in three eyes after cataract surgery and in one eye after infectious keratitis. In cases with previous PKP, AS-OCT demonstrated rupture of Descemet’s membrane (DM) in five eyes and spontaneous reattachment was found in four eyes within 8 weeks of initial diagnosis, with no rupture of DM in any of the cases. There was no rupture of DM in corneas without previous PKP. After prior keratoplasty, definitive surgical treatment was repeat PKP in 13 eyes and Air/Gas-Descemetopexy in one eye. In corneas without prior keratoplasty, three eyes underwent PKP and one eye Air/Gas-Descemetopexy. Histological examination of two corneal explants revealed a severely thinned graft-host junction and a disrupted DM close to the graft-host junction. Visual acuity improved from 1.80 ± 0.58 logMAR to 0.75 ± 0.69 logMAR after prior PKP and from 1.45 ± 0.65 logMAR to 0.85 ± 1.13 logMAR without prior PKP. The postoperative course was uneventful in 16 of 18 eyes.

Conclusion

PKP is an effective treatment option for complicated DMD, especially in ectatic corneas, whereas Air/Gas-Descemetopexy or Descemet Membrane Endothelial Keratoplasty do not address the primary issue of the curvature anomaly.

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Title: Surgical management of complicated Descemet’s membrane detachment in corneas without prior endothelial keratoplasty
Authors: Tim Berger
Berthold Seitz
Elias Flockerzi
Shady Suffo
Fidelis A. Flockerzi
Maximilian Berger
Nóra Szentmáry
Loay Daas
Publication date: 08-09-2023
Publisher: Springer Berlin Heidelberg
Keywords: Keratoplasty
Cataract
Published in: Graefe's Archive for Clinical and Experimental Ophthalmology / Issue 3/2024
Print ISSN: 0721-832X
Electronic ISSN: 1435-702X
DOI: https://doi.org/10.1007/s00417-023-06231-w

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Surgical management of complicated Descemet’s membrane detachment in corneas without prior endothelial keratoplasty

Abstract

Purpose

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

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