Abstract
We describe the use of anterior segment optical coherence tomography in the diagnosis of inadvertent retention of Descemet’s membrane (DM) after penetrating keratoplasty, and a novel technique for its removal in a case of congenital hereditary endothelial dystrophy. In this technique, we use a modification of the shifting bubble technique, commonly used in deep anterior lamellar keratoplasty where a viscocohesive ophthalmic viscosurgical device is injected into the false anterior chamber which causes migration of the central air bubble placed in the anterior chamber peripherally and helps in confirming the correct space. The DM is then peeled in a circular fashion with the help of 23-G vitreoretinal micro forceps.
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References
Leigh AG (1962) Complications of corneal grafting. In: Trevor-Roper PD (ed) Diseases of the cornea. International ophthalmology clinics, vol 2, no. 3. Little, Brown, Boston, p 757
Lazar M, Loewenstein A, Geyer O (1991) Intentional retention of Descemet’s membrane during keratoplasty. Acta Ophthalmol (Copenh) 69:111–112
Frederick SB (2009) Corneal surgery: theory, technique and tissue, 4th edn. Mosby, St. Louis, MO, p 452
Heindl LM, Cursiefen C (2010) Retained Descemet’s membrane after penetrating keratoplasty for macular corneal dystrophy. Ophthalmologe 107:55–59
Vengayil S, Vanathi M, Panda A, Khokhar S (2008) Anterior segment OCT-based diagnosis and management of retained Descemet’s membrane following penetrating keratoplasty. Cont Lens Anterior Eye 31:161–163
Sinha R, Vajpayee RB, Sharma N, Titiyal JS, Tandon R (2003) Trypan blue assisted descemetorhexis for inadvertently retained Descemet’s membranes after penetrating keratoplasty. Br J Ophthalmol 87:654–655
Lifshitz T, Oshry T, Rosenthal G (2001) Retrocorneal membrane after penetrating keratoplasty. Ophthalmic Surg Lasers 32:159–161
Foroutan AR, Dastjerdi MH (2007) Shifting-bubble sign in big-bubble technique in deep anterior lamellar keratoplasty. Cornea 26:117; author reply 117–118
Jhanji V, Beltz J, Sharma N, Graue E, Vajpayee RB (2011) “Double bubble” deep anterior lamellar keratoplasty for management of corneal stromal pathologies. Int Ophthalmol 31(4):257–262
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The article was not presented in any meeting. The authors did not receive any financial support from any public or private source. The authors have no financial or proprietary interest in a product, method, or material described herein.
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A limbal paracentesis is first made. Trypan blue dye is injected in the supernumerary space to stain the DM. It is then flushed with BSS. Healon is then injected in this space and under the slit section of the microscope, the membrane is identified and peeled using end opening micro-vitreoretinal forceps. Healon is removed bimanually from the anterior chamber at the end. (WMV 32959 kb)
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Khokhar, S., Agarwal, T., Gupta, S. et al. Shifting bubble-guided sutureless technique for performing descemetorhexis for retained Descemet’s membrane after penetrating keratoplasty. Int Ophthalmol 34, 125–128 (2014). https://doi.org/10.1007/s10792-013-9746-2
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DOI: https://doi.org/10.1007/s10792-013-9746-2