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PHOTO ESSAY
Year : 2021  |  Volume : 1  |  Issue : 4  |  Page : 802-803

A full piece of Descemet membrane detachment after neodymium: yttrium–aluminum garnet laser peripheral iridotomy


Department of Ophthalmology, Lanzhou University Second Hospital, Lanzhou, China

Date of Submission23-Feb-2021
Date of Acceptance16-Mar-2021
Date of Web Publication09-Oct-2021

Correspondence Address:
Dr. Peng Lu
Glaucoma Services, Department of Ophthalmology, Lanzhou University Second Hospital, Lanzhou - 730 030
China
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijo.IJO_465_21

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  Abstract 


Keywords: Complications, Descemet membrane detachment, laser peripheral iridotomy (LPI), Nd:YAG


How to cite this article:
Lu P, Wang J, Wang Y. A full piece of Descemet membrane detachment after neodymium: yttrium–aluminum garnet laser peripheral iridotomy. Indian J Ophthalmol Case Rep 2021;1:802-3

How to cite this URL:
Lu P, Wang J, Wang Y. A full piece of Descemet membrane detachment after neodymium: yttrium–aluminum garnet laser peripheral iridotomy. Indian J Ophthalmol Case Rep [serial online] 2021 [cited 2021 Oct 26];1:802-3. Available from: https://www.ijoreports.in/text.asp?2021/1/4/802/327692



The most common laser and the well-established procedure is neodymium: yttrium–aluminum garnet (Nd:YAG) laser peripheral iridotomy (LPI) in the treatment and prevention of primary angle-closure glaucoma (PACG).[1] Nd:YAG LPI is a relatively safe procedure; however, complications happen, including blinding complications such as detachment of Descemet membrane (DM) and corneal endothelial decompensation.[2],[3],[4]

We report a 64-year-old Chinese woman who has undergone LPI in treatment of PACG find out a small piece full detachment of DM in the anterior chamber (AC) [Figure 1], [Figure 2], [Figure 3]. [Figure 4] shows the UBM image of the laser peripheral iridotomy site. In the 3 years of follow-up, the intraocular pressure (IOP) post-LPI was well controlled in her the right eye without any anti-glaucoma agents, and the small piece full detachment of DM has remained at the same place unchanged [Figure 5].
Figure 1: Anterior photo of the right eye in 2017, showing the small full piece detachment of Descemet membrane. (white arrow)

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Figure 2: Slit-lamp photo of right eye in 2017, showing the detached Descemet membrane. (white arrow)

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Figure 3: ASOCT image of the right eye, showing the detached Descemet membrane detached from the cornea (big arrow) and the fully detached Descemet membrane. (small arrow)

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Figure 4: UBM image of the right eye, showing the laser peripheral iridotomy (big arrow) and the iris surface split tissue. (small arrow)

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Figure 5: Anterior photo of the right eye in 2020 showing a small cornea focal opacity and the small piece full detachment of Descemet membrane has remained at the same place unchanged. (white arrow)

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  Discussion Top


Nd:YAG LPI has been reported to have some complications such as hyphema, transient IOP elevation, inflammation, and others. DM detachment and endothelial decompensation can be yet another blinding complication of LPI.[3],[4]

In this case, LPI was done by hitting the laser beam directly on the iris without using condensing lenses, we suggest if the patient has a relatively shallow chamber or not well cooperative, a condensing lens like Abraham's lens or Blumenthal lens should be used to facilitate the process with a clearer view of the iridotomy site while to stable eyeball, better access to the peripheral area of the iris, the greater concentration of laser power make the lens-assisted PI very helpful especially for beginners.[5] Awareness of these potential complications of LPI will aid in planning.

Patient consent

The patient consented to the publication of the case in writing.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Kumar H, Mansoori T, Warjri GB, Somarajan BI, Bandil S, Gupta V. Lasers in glaucoma. Indian J Ophthalmol Case Rep2018;66:1539-53.  Back to cited text no. 1
    
2.
Radhakrishnan S, Chen PP, Junk AK, Nouri-Mahdavi K, Chen TC. Laser peripheral iridotomy in primary angle closure: A report by the American Academy of Ophthalmology. Ophthalmology 2018;125:1110-20.  Back to cited text no. 2
    
3.
Wang PX, Koh VT, Loon SC. Laser iridotomy and the corneal endothelium: A systemic review. Acta Ophthalmol 2014;92:604-16.  Back to cited text no. 3
    
4.
Fu Y, Zhou W, Li W, Lin X, Dai Q. Late-onset descemet membrane detachment and corneal decompensation after laser peripheral iridotomy: A case report. Medicine (Baltimore) 2018;97:e0083.  Back to cited text no. 4
    
5.
Kam JP, Zepeda EM, Ding L, Wen JC. Resident-performed laser peripheral iridotomy in primary angle closure, primary angle closure suspects, and primary angle closure glaucoma. Clin Ophthalmol 2017;11:1871-6.  Back to cited text no. 5
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5]



 

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