Predescemetic hemorrhage: two cases, two options in management

Session Details

Session Title: Presented Poster Session: Corneal Cross-Linking

Venue: Poster Village: Pod 3

First Author: : D.Ortiz Vaquerizas SPAIN

Co Author(s): :    M. Garat Chifflet   S. Duch Tuesta                    

Abstract Details

Purpose:

To describe two methods of resolving a predescemetic hemorrhage after Non-Penetrating Deep Sclerectomy (NPDS).

Setting:

Hemorrhagic Descemet membrane detachment (DMD) is a rare complication after glaucoma surgery. It has been reported mostly after canaloplasty. It’s treatment options involve: Nd:YAG laser, tissue plasminogen activator (TPA), aspiration of blood and descemetopexy with air tamponade.

Methods:

Case report. Case 1: 88-year-old woman who presented a predescemetic blood level after combined surgery of NPDS and phacoemulsification of cataract with intraocular lens implant in the right eye. Goniopuncture was performed and also Nd:YAG laser on the Descemet of the DMD. Case 2: a 54-year-old woman arrived with a hemorrhagic DMD after massage maneuver on previous NPDS, almost to the visual axis. Goniopuncture and Trendelenburg position were performed.

Results:

Case1: hemorrhage drained to anterior chamber (AC). One week later, corneal edema (CE) appeared in laser area, but it solved with hypertonic solution eye drops. Nowadays, Descemet shows adherence to stroma and three endothelial scars are seen in the laser area, without CE. Case : hemorrhage drained, but presented persistence of DMD and CE. Air injection into AC and supine position were performed. At 24-hour-control, Descemet was adhered, CE disappeared, and air bubble was visible. However, at one-week control DMD relapsed. We performed transfixion stitch in DMD periphery, air injection and positioning. Total Descemet adhesion was achieved and CE disappeared.

Conclusions:

Predescemetic hemorrhage is a uncommon but possible complication after glaucoma surgery, either by the surgery itself or by the maneuvers performed after it. Goniopuncture can help in its drainage by creating a flow into the subconjunctival space. The Nd:YAG laser on Descemet and the combination of positioning and injection of air in AC are two possible therapeutic maneuvers. In cases of persistent DMD, a peripheral transfixion stitch in the area of detachment may be definitive for resolution.

Financial Disclosure:

None