We read with interest the study by Odayappan et al regarding outcomes of air descemetopexy for Descemet membrane detachment (DMD). [1] It is interesting to note the lack of corneal pathology associated with DMD in their case series, and the discussion regarding the contribution of incision sites. We would like to raise the issue of peripheral corneal pathology as a contributing factor in DMD. Recently we had a complex case involving a 91-year-old with extensive Terrien’s marginal degeneration and corneal scarring, who underwent right cataract surgery. This was complicated by DMD and he had successful air descemetopexy within the first month. He then proceeded to have left cataract surgery, with a residual air bubble left in the anterior chamber, yet he still developed DMD. We scheduled surgery but he was unable to attend due to illness and hospital admission. When he was reviewed at 3 months post operatively, the DMD had reattached, with normalised pachymetry and visual acuity of 6/12 bilaterally.
While we agree that air descemetopexy is an efficient treatment modality for DMD, our case highlights that other co-morbidities can influence management. As the anatomical and visual outcomes were similar in both eyes, our case raises the issue of lack of clear guidance in the literature regarding when to intervene in DMD and when to observe.
Terrien’s marginal degeneration is a slowly progressive thinning of the peripheral cornea, with formation of a scarred gutter due to stromal degeneration. We wonder if wound architecture during cataract surgery is compromised in this setting, predisposing to DMD. Previous reports have encouraged the use of ultrasound and topography in the diagnosis of Terrien’s. [2,3] We recommend the use of anterior segment OCT as an invaluable adjunct in diagnosing peripheral corneal pathology, for confirming the diagnosis of DMD, and monitoring progress.
References:
1. Odayappan A, Shivananda N, Ramakrishnan S, Krishnan T, Nachiappan S, Krishnamurthy S. A retrospective study on the incidence of post-cataract surgery Descemet's membrane detachment and outcome of air descemetopexy. Br J Ophthalmol. 2017 Jun 13. pii: bjophthalmol-2016-309766. doi:
10.1136/bjophthalmol-2016-309766. [Epub ahead of print]
2. Skribek A, Sohár N, Gyetvai T, Nógrádi A, Kolozsvári L. Role of ultrasound biomicroscopy in diagnosis and treatment of Terrien disease. Cornea. 2008 May;27(4):427-33.
3. Fernandes M. Scanning slit topography: diagnostic boon in presumed unilateral Terrien's marginal degeneration. Cont Lens Anterior Eye. 2011 Dec;34(6):282-6.
We read with interest the study by Odayappan et al regarding outcomes of air descemetopexy for Descemet membrane detachment (DMD). [1] It is interesting to note the lack of corneal pathology associated with DMD in their case series, and the discussion regarding the contribution of incision sites. We would like to raise the issue of peripheral corneal pathology as a contributing factor in DMD. Recently we had a complex case involving a 91-year-old with extensive Terrien’s marginal degeneration and corneal scarring, who underwent right cataract surgery. This was complicated by DMD and he had successful air descemetopexy within the first month. He then proceeded to have left cataract surgery, with a residual air bubble left in the anterior chamber, yet he still developed DMD. We scheduled surgery but he was unable to attend due to illness and hospital admission. When he was reviewed at 3 months post operatively, the DMD had reattached, with normalised pachymetry and visual acuity of 6/12 bilaterally.
While we agree that air descemetopexy is an efficient treatment modality for DMD, our case highlights that other co-morbidities can influence management. As the anatomical and visual outcomes were similar in both eyes, our case raises the issue of lack of clear guidance in the literature regarding when to intervene in DMD and when to observe.
Terrien’s marginal degeneration is a slowly progressive thinning of the peripheral cornea, with formation of a scarred gutter due to stromal degeneration. We wonder if wound architecture during cataract surgery is compromised in this setting, predisposing to DMD. Previous reports have encouraged the use of ultrasound and topography in the diagnosis of Terrien’s. [2,3] We recommend the use of anterior segment OCT as an invaluable adjunct in diagnosing peripheral corneal pathology, for confirming the diagnosis of DMD, and monitoring progress.
References:
1. Odayappan A, Shivananda N, Ramakrishnan S, Krishnan T, Nachiappan S, Krishnamurthy S. A retrospective study on the incidence of post-cataract surgery Descemet's membrane detachment and outcome of air descemetopexy. Br J Ophthalmol. 2017 Jun 13. pii: bjophthalmol-2016-309766. doi:
10.1136/bjophthalmol-2016-309766. [Epub ahead of print]
2. Skribek A, Sohár N, Gyetvai T, Nógrádi A, Kolozsvári L. Role of ultrasound biomicroscopy in diagnosis and treatment of Terrien disease. Cornea. 2008 May;27(4):427-33.
3. Fernandes M. Scanning slit topography: diagnostic boon in presumed unilateral Terrien's marginal degeneration. Cont Lens Anterior Eye. 2011 Dec;34(6):282-6.