Technique to visualize the Descemet defect in severe hydrops
First Author: Z.Ashena UK
Co Author(s): M. Nanavaty
To present a case of extensive hydrops with severe corneal oedema, which did not allow clinical or anterior segment ocular coherence tomography (OCT) diagnosis of the Descemet membrane (DM) tear, to locate the DM tear prior to full thickness corneal suturing
Sussex Eye Hospital, Brighton & Sussex University Hospitals NHS Trust, Brighton, UK
A 22-year-old keratoconic patient with acute hydrops and best corrected visual acuity (BCVA) of counting fingers was offered corneal suturing after commencing medical therapy. His cornea had extensive oedema with no visibility of the DM break on the slit lamp or anterior segment OCT examination. On the operating table small amount of air was injected into the anterior chamber through a paracentesis. After waiting for five minutes, with partial resolution of oedema, two DM breaks became evident. Four full thickness 10-0 nylon sutures were placed to attach the detached DM followed by complete removal of air from the anterior chamber.
The patient was reviewed one week, 1 and 2 months after the surgery. The sutures were removed after 2 months. The pain and photophobia resolved within a week and his BCVA improved to 6/18 with pinhole, which was similar to his vision prior to hydrops. Corneal oedema resolved with attachment of DM and his central corneal thickness significantly decreased.
In severe hydrops, where the anterior segment OCT is not capable of locating the DM defect, small intracameral air injection provides tamponade to the detached DM and decreases corneal oedema to the extent that DM break becomes visible. This helps the surgeon to place corneal sutures to the right locus