Sweating of Descemet's membrane during deep anterior lamellar keratoplasty in absence of perforation

Karim Mohamed-Noriega,1,2 Jodhbir S Mehta1–41Tissue Engineering and Stem Cell Group, Singapore Eye Research Institute, 2Corneal and External Disease Service, Singapore National Eye Centre, 3Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore,...

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Autores principales: Mohamed-Noriega K, Mehta JS
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Lenguaje:EN
Publicado: Dove Medical Press 2012
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spelling oai:doaj.org-article:ecfdabc767b94ffeb713bc4108a67c0c2021-12-02T11:40:36ZSweating of Descemet's membrane during deep anterior lamellar keratoplasty in absence of perforation1177-54671177-5483https://doaj.org/article/ecfdabc767b94ffeb713bc4108a67c0c2012-09-01T00:00:00Zhttp://www.dovepress.com/sweating-of-descemet39s-membrane-during-deep-anterior-lamellar-keratop-a10913https://doaj.org/toc/1177-5467https://doaj.org/toc/1177-5483Karim Mohamed-Noriega,1,2 Jodhbir S Mehta1–41Tissue Engineering and Stem Cell Group, Singapore Eye Research Institute, 2Corneal and External Disease Service, Singapore National Eye Centre, 3Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore, 4Department of Clinical Sciences, Duke-NUS Graduate Medical School, SingaporeAbstract: We report a case of spontaneous Descemet's membrane sweating of aqueous humor during a manual deep anterior lamellar keratoplasty (DALK) without perforation of Descemet's membrane. An 81-year-old female developed a neurotrophic central ulcer with descemetocele in the right eye, and her visual acuity was count fingers at 30 cm. She was unresponsive to medical treatment, and an uneventful manual DALK was performed. Six months after surgery, unaided visual acuity improved to 6/30. Seven months after surgery, the patient had a decrease in visual acuity to count fingers in the same eye. She was diagnosed as having corneal melting with a central descemetocele in the previous lamellar graft. A repeat manual DALK graft was performed. Lamellar dissection was performed starting from the edge of descemetocele, proceeding to the corneal periphery and maintaining the surgical plane of the previous DALK. During the surgical procedure, continuous and localized sweating of aqueous through Descemet's membrane was observed in the area of the descemetocele. After drying of the recipient bed, no visible perforation of Descemet's membrane was found. After removal of the previous DALK graft, a new stromal lamellar graft was sutured. The surgery was concluded without complications. One day after surgery, the graft was clear, with no detachment of Descemet's membrane. If Descemet's membrane sweating is observed during DALK and there is no visible perforation, the reason may be a hidden micron perforation in an intact Descemet's membrane. It is recommended to continue with surgery maintaining maximum diligence and low intraocular pressure to prevent extension of micron perforation.Keywords: deep anterior lamellar keratoplasty, perforation, Descemet's membrane, sweatingMohamed-Noriega KMehta JSDove Medical PressarticleOphthalmologyRE1-994ENClinical Ophthalmology, Vol 2012, Iss default, Pp 1441-1443 (2012)
institution DOAJ
collection DOAJ
language EN
topic Ophthalmology
RE1-994
spellingShingle Ophthalmology
RE1-994
Mohamed-Noriega K
Mehta JS
Sweating of Descemet's membrane during deep anterior lamellar keratoplasty in absence of perforation
description Karim Mohamed-Noriega,1,2 Jodhbir S Mehta1–41Tissue Engineering and Stem Cell Group, Singapore Eye Research Institute, 2Corneal and External Disease Service, Singapore National Eye Centre, 3Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore, 4Department of Clinical Sciences, Duke-NUS Graduate Medical School, SingaporeAbstract: We report a case of spontaneous Descemet's membrane sweating of aqueous humor during a manual deep anterior lamellar keratoplasty (DALK) without perforation of Descemet's membrane. An 81-year-old female developed a neurotrophic central ulcer with descemetocele in the right eye, and her visual acuity was count fingers at 30 cm. She was unresponsive to medical treatment, and an uneventful manual DALK was performed. Six months after surgery, unaided visual acuity improved to 6/30. Seven months after surgery, the patient had a decrease in visual acuity to count fingers in the same eye. She was diagnosed as having corneal melting with a central descemetocele in the previous lamellar graft. A repeat manual DALK graft was performed. Lamellar dissection was performed starting from the edge of descemetocele, proceeding to the corneal periphery and maintaining the surgical plane of the previous DALK. During the surgical procedure, continuous and localized sweating of aqueous through Descemet's membrane was observed in the area of the descemetocele. After drying of the recipient bed, no visible perforation of Descemet's membrane was found. After removal of the previous DALK graft, a new stromal lamellar graft was sutured. The surgery was concluded without complications. One day after surgery, the graft was clear, with no detachment of Descemet's membrane. If Descemet's membrane sweating is observed during DALK and there is no visible perforation, the reason may be a hidden micron perforation in an intact Descemet's membrane. It is recommended to continue with surgery maintaining maximum diligence and low intraocular pressure to prevent extension of micron perforation.Keywords: deep anterior lamellar keratoplasty, perforation, Descemet's membrane, sweating
format article
author Mohamed-Noriega K
Mehta JS
author_facet Mohamed-Noriega K
Mehta JS
author_sort Mohamed-Noriega K
title Sweating of Descemet's membrane during deep anterior lamellar keratoplasty in absence of perforation
title_short Sweating of Descemet's membrane during deep anterior lamellar keratoplasty in absence of perforation
title_full Sweating of Descemet's membrane during deep anterior lamellar keratoplasty in absence of perforation
title_fullStr Sweating of Descemet's membrane during deep anterior lamellar keratoplasty in absence of perforation
title_full_unstemmed Sweating of Descemet's membrane during deep anterior lamellar keratoplasty in absence of perforation
title_sort sweating of descemet's membrane during deep anterior lamellar keratoplasty in absence of perforation
publisher Dove Medical Press
publishDate 2012
url https://doaj.org/article/ecfdabc767b94ffeb713bc4108a67c0c
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