Descemet Membrane Detachment After Filtering Glaucoma Surgery In Keratoconus

Published 2022 - 40th Congress of the ESCRS

Reference: PO300 | Type: ESCRS 2022 - Posters | DOI: 10.82333/a1h9-h684

Authors: Guillermo Rodríguez Iranzo* ¹ , Santiago Montolío Marzo ¹ , Jose Vicente Piá Ludeña ¹ , Ester Fernández López ¹ , Aitor Lanzagorta Aresti ¹ , Cristina Peris Martínez ¹

¹FISABIO Oftalmología Médica,Valencia,Spain

Purpose

Descemet membrane detachment (DMD) has been reported after glaucoma surgery. It is more frequent after canaloplasty and a rare complication after non-perforating deep sclerectomy (DPDS). DPDS allows fluid to flow behind the stroma separating it from the Descemet´s membrane, even with normal postoperative intraocular pressures (IOP). Besides the role of glaucoma surgery, keratoconus patients show histopathological and molecular changes that weaken the cornea and predispose to the appearance of spontaneous or traumatic DMD. Therefore, we must be concerned of risk factors for DMD in glaucoma patients with keratoconus.

Setting

Fisabio Oftalmología Médica, Valencia, Spain

Methods

We report the case of a 42-year-old man with a history of bilateral keratoconus and no disease progression, referred with an uncontrolled glaucoma in his left eye (LE) despite of maximum medical treatment (oral acetazolamide once a day, topical dorzolamide-timolol and brimonidine twice a day). LE best corrected visual acuity was 0.2, IOP was 50 mmHg, with wide anterior chamber and opened iridocorneal angle. Papillary excavation was 0.9 and topographic study showed a stage II (moderate) keratoconus. NPDS was indicated and performed without complications, including the immediate postopoperative weeks, in which IOP remained within normal limits.

Results

Our patient showed DMD 5 weeks after DPDS. The trabeculo-descemetic membrane made in DPDS creates a new route for aqueous to flow behind corneal stroma. Increased IOP, formation of big filtering blisters or a tenon cyst may promote the development of DMD but in this case IOP was within normal limits in the postoperative period, even at the moment when DMD was detected. Keratoconus may have played a role in DMD formation in a patient with uncomplicated surgery and normal IOP. Keratoconus patients show alterations at the level of the stroma-Descemet junction showing Descemet´s membrane folds with pleomorphism or polymegetism of endothelial cells and even complete spontaneous Descemet´s rupture that can lead to corneal hydrops.

Conclusions

There is a genetic susceptibility, as well as an individual predisposition for the appearance of DMD based on alterations in the adhesion between the posterior stroma and Descemet´s membrane. DMD after NPDS is rare, even more after uncomplicated surgery with no IOP rise. Nevertheless, our patient also showed distorted cornea due to keratoconus. Both circumstances may led to the appearance of DMD.