Posters

Raised intraocular pressure (IOP) secondary to retained host Descemet's membrane (DM) scroll post DMEK

Poster Details

First Author: T. Khanam UK

Co Author(s): A. Mearza   T. Patel                 

Abstract Details

Purpose:

To describe a unique case of post-operative intra-ocular pressure spiking post DMEK surgery secondary to a residual scroll of host DM.

Setting:

Imperial College Healthcare NHS Trust

Methods:

A 70-year-old lady underwent routine left DMEK surgery but during the post-operative recovery period, although the DMEK graft was functioning well and the vision had improved there was a problem with raised intra-ocular pressure. Initially this was thought to be due to a steroid response but despite switching to NSAID's and being on maximal IOP lowering treatment as advised by our glaucoma colleagues, the pressure in the left eye continued to spike above 50 mmHg. This resulted in several visits to casualty. The only abnormality noted in the anterior chamber was a residual scroll of host DM superiorly.

Results:

Given the multiple presentations, a decision was made to remove the residual scroll in the operating theatre, which was done uneventfully. Following this, the pressure returned to normal limits with a reduced requirement for medication and no further spiking of pressure occurred.

Conclusions:

We suggest that the patho-physiology of this presentation was that there was shedding of endothelial cells from the retained host scroll, which was blocking the trabecular meshwork, and therefore causing the pressure to rise with associated spikes. This presentation has not to our knowledge been described previously and we would advise that in the event of spiking of IOP's following DSAEK or DMEK, one should be observant for the presence of retained host scrolls of DM. If present, these should be removed as soon as possible to prevent permanent damage to the optic nerve.

Financial Disclosure:

None