Spontaneous Descemet Membrane Detachment After Necrotizing Scleritis: A Case Report

Area of Science:

• Ophthalmology
• Corneal Diseases
• Autoimmune Disorders

Background:

• Necrotizing scleritis is a severe inflammatory condition affecting the sclera.
• Descemet membrane detachment (DMD) can cause significant visual impairment.
• Systemic immunosuppression is often required for managing necrotizing scleritis.

Purpose of the Study:

• To report the first case of spontaneous Descemet membrane detachment (DMD) in a patient with a history of necrotizing scleritis.
• To discuss the management strategy and clinical outcome for this rare presentation.
• To explore potential mechanisms linking necrotizing scleritis and DMD.

Main Methods:

• Case report and literature review.
• Clinical examination including slit lamp photography and anterior segment optical coherence tomography (AS-OCT).
• Management involved systemic corticosteroids and intracameral air injection.

Main Results:

• A 50-year-old male with a history of autoimmune conditions and necrotizing scleritis presented with photophobia, pain, and decreased vision.
• AS-OCT confirmed Descemet membrane detachment (DMD) with associated bullous corneal edema.
• Treatment with increased systemic steroids followed by air bubble injection resulted in DMD reattachment and vision improvement to 20/25.

Conclusions:

• Spontaneous DMD is a rare complication that can occur in patients with a history of necrotizing scleritis.
• Shearing forces due to scleral ectasia may be a potential mechanism for DMD in this context.
• A combined approach of systemic immunosuppression and intracameral air injection can effectively manage this condition.