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Published on: September 17, 2014
Descemet's Membrane Detachment Management Following Trabeculectomy
Farideh Sharifipour1, Saman Nassiri1, Aida Idan2
1Department of Ophthalmology, Imam Khomeini Hospital, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.
Purpose:
To present a case of total Descemet's membrane detachment (DMD) after trabeculectomy and its surgical management.
Case Report:
A 68-year-old woman presented with large DMD and corneal edema one day after trabeculectomy. Intracameral air injection on day 3 was not effective. Choroidal effusion complicated the clinical picture with Descemet's membrane (DM) touching the lens. Choroidal tap with air injection on day 6 resulted in DM attachment and totally clear cornea on the next day. However, on day 12 the same scenario was repeated with choroidal effusion, shallow anterior chamber (AC), and DM touching the lens. The third surgery included transconjunctival closure of the scleral flap with 10/0 nylon sutures, choroidal tap, and intracameral injection of 20% sulfur hexafluoride. After the third surgery, DM remained attached with clear cornea. Suture removal and needling bleb revision preserved bleb function. Lens opacity progressed, and the patient underwent uneventful cataract surgery 4 months later.
Conclusion:
Scleral flap closure using transconjunctival sutures can be used for DMD after trabeculectomy to make the eye a closed system. Surgical drainage of choroidal effusions should be considered to increase the AC depth.
