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PHOTO ESSAY
Year : 2021  |  Volume : 1  |  Issue : 2  |  Page : 194-195

Spontaneous Descemet's membrane detachment from Haab's striae


1 Smt Jadhavbhai Nathamal Singhvee Glaucoma Services, Sankara Nethralaya, Medical Research Foundation, Chennai, Tamil Nadu, India
2 Department of Cornea and Refractive Surgery, Sankara Nethralaya, Medical Research Foundation, Chennai, Tamil Nadu, India
3 Glaucoma Services, Sankara Nethralaya, Medical Research Foundation, Kolkata, West Bengal, India

Date of Submission03-Jun-2020
Date of Acceptance29-Oct-2020
Date of Web Publication01-Apr-2021

Correspondence Address:
Dr. Sripriya Krishnamoorthy
Smt Jadhavbhai Nathamal Singhvee Glaucoma Services, Sankara Nethralaya, Medical Research Foundation, 18, College Road, Nungambakkam, Chennai - 600 018, Tamil Nadu
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijo.IJO_1737_20

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  Abstract 


Keywords: Acute hydrops, descemetopexy, Haab's striae, intracameral air, spontaneous detachment of Descemet's membrane


How to cite this article:
Krishnamoorthy S, Srinivasan B, Sen S, Agarwal M, Balekudaru S. Spontaneous Descemet's membrane detachment from Haab's striae. Indian J Ophthalmol Case Rep 2021;1:194-5

How to cite this URL:
Krishnamoorthy S, Srinivasan B, Sen S, Agarwal M, Balekudaru S. Spontaneous Descemet's membrane detachment from Haab's striae. Indian J Ophthalmol Case Rep [serial online] 2021 [cited 2021 Apr 20];1:194-5. Available from: https://www.ijoreports.in/text.asp?2021/1/2/194/312340




  Case Report Top


A 32-year-old lady with developmental glaucoma presented with sudden drop in vision to counting fingers in her only seeing left eye since two weeks. Intra-ocular pressure (IOP) was 18 mmHg on maximum tolerable anti-glaucoma medications. Slit-lamp examination revealed diffuse corneal edema with large planar Descemet's membrane (DM) detachment (Type-2) [Figure 1]a and [Figure 1]b that seemed to arise from the Haab's striae [Figure 1]c.[1] In view of one-eyed status, duration since DM detachment, large area of DM separation and need for early trabeculectomy, the option of descemetopexy was considered. She underwent air descemetopexy with full-thickness corneal suturing of the DM tear. Post-operatively corneal edema cleared [Figure 2]a and [Figure 2]b, DM was attached [Figure 2]c, and vision dramatically improved to 20/40. Ten days later she underwent an uneventful trabeculectomy with precautions to maintain a stable anterior chamber [Figure 3].
Figure 1: (a) Slit-lamp photograph of left eye in diffuse illumination showing area of Haab's striae (depicted by yellow arrow), and diffuse stromal edema involving 2/3rd of cornea. (b) Slit-lamp photograph of left eye in slit-beam with yellow arrows showing the Descemet's membrane detachment. (c) Anterior segment-optical coherence tomography showing attached inferior end of Descemet's membrane (inferior corneal thickness = 632 μm) with central and superior planar (Type-2) Descemet's membrane detachment shown by yellow arrow with maximum separation of 902 μm from stroma (superior corneal thickness = 912 μm)

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Figure 2: (a) Slit-lamp photograph of left eye in diffuse illumination on first post-operative day showing improved corneal clarity, better view of anterior chamber details with intracameral air. (b) Slit-lamp photograph of left eye in slit-beam with attached Descemet's membrane and 2 full-thickness corneal sutures shown by 2 yellow arrows. (c) Anterior segment-optical coherence tomography image showing attached Descemet's membrane including edges of Haab's striae (shown by 2 yellow arrows) and reduced corneal thickness (647 μm) centrally comparable to undetached inferior corneal thickness (632 μm) noted pre-operatively

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Figure 3: Slit-lamp photograph of the left eye in diffuse illumination with maintained corneal clarity with scarred margins of the Haab's striae post trabeculectomy

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  Discussion Top


Acute hydrops of congenital glaucoma[2] occur due to raised IOP causing sudden stromal hydration through a DM tear or Haab's striae. The healthy surrounding endothelium resolves the corneal edema once IOP is brought under control. Acute hydrops of keratoconus responds to conservative management except when tear is large needing descemetopexy/suturing/venting incision.[3],[4],[5] Hydrops due to reopening of Haab's striae in an adult has not been reported commonly. In our case, increase in IOP probably resulted in DM stretching and opening up of the Haab's striae. High IOP, superior location of Haab's striae and poor endothelial function (topical carbonic anhydrase inhibitors and previous intraocular surgery) facilitated separation of DM. Air descemetopexy with corneal suturing was performed as air is less toxic on endothelium than C3F8, has no risk of expansion, can tamponade superior DM breaks well and gets absorbed faster giving early visual recovery in the one-eyed lady, and the suturing helped us avoid prolonged full fill in a glaucomatous eye.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Dua HS, Sinha R, D'Souza S, Potgieter F, Ross A, Kenawy M, et al. “Descemet Membrane Detachment”: A novel concept in diagnosis and classification. Am J Ophthalmol 2020;218:84-98.  Back to cited text no. 1
    
2.
Mandal AK. Acute corneal hydrops in children with primary infantile glaucoma: A report of 31 cases over 23 years at the LVPEI. PLoS One 2016;11:e0156108.  Back to cited text no. 2
    
3.
Ting DS, Srinivasan S. Pneumodescemetopexy with perfluoroethane (C 2 F 6) for the treatment of acute hydrops secondary to keratoconus. Eye (Lond) 2014;28:847-51.  Back to cited text no. 3
    
4.
Tuft SJ, Gregory WM, Buckley RJ. Acute corneal hydrops in keratoconus. Ophthalmology 1994;101:1738-44.  Back to cited text no. 4
    
5.
Grewal S, Laibson PR, Cohen EJ, Rapuano CJ. Acute hydrops in the corneal ectasias: associated factors and outcomes. Trans Am OphthalmolSoc 1999;97:187.  Back to cited text no. 5
    


    Figures

  [Figure 1], [Figure 2], [Figure 3]



 

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