RESUMO
PURPOSE: Descemet´s membrane ruptures (with a discontinuation of Descemet´s membrane and double detached coiled edges) in the context of complicated anterior segment surgery have rarely been described and its management can be challenging. We report a modified Descemet stripping only (DSO) technique associated with ripasudil drops to treat these cases when other techniques fail. METHODS: We describe two cases of large Descemet´s membrane detachments associated with Descemet´s ruptures after cataract surgery that did not respond to two SF6 intracameral injections. As the detached Descemet's membrane and coiled edges might have prevented endothelial cell migration, we decided to perform a modified DSO with post-operative ripasudil drops to promote corneal clearance. RESULTS: Both cases improved significantly in unaided and best corrected visual acuity (BCVA), corneal clearance and pachymetry, avoiding the need for an endothelial keratoplasty. Endothelial cells were observed on specular microscopy within the area of the descemetorhexis. CONCLUSION: DSO with ripasudil drops might be a valuable tool to recover corneal clearance and avoid endothelial keratoplasty in complex Descemet´s membrane detachments with ruptures that do not respond to other treatments.
Assuntos
Ceratoplastia Endotelial com Remoção da Lâmina Limitante Posterior , Distrofia Endotelial de Fuchs , Humanos , Distrofia Endotelial de Fuchs/cirurgia , Lâmina Limitante Posterior/cirurgia , Endotélio Corneano/cirurgia , Acuidade Visual , Células Endoteliais , Ceratoplastia Endotelial com Remoção da Lâmina Limitante Posterior/métodosRESUMO
El desprendimiento de la membrana de Descemet es una complicación infrecuente de la cirugía intraocular que puede resultar devastadora si no se diagnostica y se trata a tiempo. Habitualmente está asociado a la cirugía de la catarata, aunque tiene múltiples etiologías. Existen tratamientos muy variados, desde la simple observación hasta la queratoplastia penetrante. Se presenta una paciente femenina de 66 años de edad, con antecedentes de salud, quien fue operada de catarata del ojo derecho por la técnica de facoemulsificación con implante de lente intraocular de cámara posterior sin complicaciones aparentes durante la cirugía. En el posoperatorio presentó a las 24 horas edema corneal tres cruces con tensión ocular normal, el cual se mantuvo durante la primera semana a pesar del tratamiento intensivo con cloruro de sodio hipertónico y antinflamatorios esteroideos. No se recogieron alteraciones del endotelio corneal previas a la cirugía. En las imágenes de Scheimpflug del pentacam se observó desprendimiento de la membrana de Descemet en distintos puntos. Se realizó neumopexia y a las 24 horas la córnea se encontraba transparente(AU)
Descemet´s membrane detachment is an uncommon complication of the intraocular surgery that can be devastating if it is not diagnosed and treated on time. It is usually associated to cataract surgery, although has multiple etiologies. Treatments vary from the simple observation to the penetrating keratoplasty. This is the case of a 66 year-old woman, with a history of health problems, who was operated on of cataract in her right eye through the phacoemulsification technique with posterior chamber intraocular lens implantation without apparent complications during surgery. After 24 hours, she presented with corneal edema, three crosses and normal ocular pressure. She remained with the same condition during the first week despite treatment with hypertonic sodium chloride and steroid anti-inflammatory drugs. There were no alterations in the corneal endothelium before surgery. Scheimpflug images in Pentacam showed Descemet´s membrane detachment in several sites. It was decided to apply pneumopexia which rendered transparent cornea after other 24 hours(AU)
Assuntos
Humanos , Feminino , Idoso , Topografia da Córnea , Lâmina Limitante Posterior , Extração de Catarata/efeitos adversos , Facoemulsificação/métodos , Lentes Intraoculares/efeitos adversos , Edema da Córnea/terapiaRESUMO
El desprendimiento de la membrana de Descemet es una complicación infrecuente de la cirugía intraocular que puede resultar devastadora si no se diagnostica y se trata a tiempo. Habitualmente está asociado a la cirugía de la catarata, aunque tiene múltiples etiologías. Existen tratamientos muy variados, desde la simple observación hasta la queratoplastia penetrante. Se presenta una paciente femenina de 66 años de edad, con antecedentes de salud, quien fue operada de catarata del ojo derecho por la técnica de facoemulsificación con implante de lente intraocular de cámara posterior sin complicaciones aparentes durante la cirugía. En el posoperatorio presentó a las 24 horas edema corneal tres cruces con tensión ocular normal, el cual se mantuvo durante la primera semana a pesar del tratamiento intensivo con cloruro de sodio hipertónico y antinflamatorios esteroideos. No se recogieron alteraciones del endotelio corneal previas a la cirugía. En las imágenes de Scheimpflug del pentacam se observó desprendimiento de la membrana de Descemet en distintos puntos. Se realizó neumopexia y a las 24 horas la córnea se encontraba transparente(AU)
Descemet´s membrane detachment is an uncommon complication of the intraocular surgery that can be devastating if it is not diagnosed and treated on time. It is usually associated to cataract surgery, although has multiple etiologies. Treatments vary from the simple observation to the penetrating keratoplasty. This is the case of a 66 year-old woman, with a history of health problems, who was operated on of cataract in her right eye through the phacoemulsification technique with posterior chamber intraocular lens implantation without apparent complications during surgery. After 24 hours, she presented with corneal edema, three crosses and normal ocular pressure. She remained with the same condition during the first week despite treatment with hypertonic sodium chloride and steroid anti-inflammatory drugs. There were no alterations in the corneal endothelium before surgery. Scheimpflug images in Pentacam showed Descemet´s membrane detachment in several sites. It was decided to apply pneumopexia which rendered transparent cornea after other 24 hours(AU)
