Descemet's membrane detachment by sodium hyaluronate

The inadvertent injection of sodium hyaluronate (Healon) just anterior to Descemet's membrane during an extracapsular cataract extraction resulted in a corneal opacity. No extraordinary measures were taken to remove this substance. The opacity resolved over five months, with a final visual acuity of 20/25 and a reduction in specular microscopic cell density from 2,600 to 2,100/sq mm. Sodium hyaluronate was injected in an analogous manner into eight rabbit corneas. The eyes were enucleated, and histologic sections were examined 1, 5, 9, and 14 days later. Sodium hyaluronate injected just anterior to Descemet's membrane was found to incite an acute mild granulocytic response, which is followed by a macrophage invasion and ingestion of this substance. We recommend a conservative approach when the central portion of Descemet's membrane is detached by sodium hyaluronate during anterior segment surgery.