Djavanmardi Shirin, Arciniegas-Perasso Carlos A, Duch Susana, Avila-Marrón Elena, Milla Elena
Glaucoma Unit, Innova Ocular ICO Barcelona.
Glaucoma Unit, Hospital Clinic, Barcelona, Spain.
J Glaucoma. 2021 Jul 1;30(7):e352-e356. doi: 10.1097/IJG.0000000000001721.
To describe 5 representative cases of hemorrhagic Descemet's membrane (DM) detachment in glaucoma surgery that had different origins, mechanisms and treatments.
Clinical records of patients that had undergone a nonpenetrating glaucoma surgery, with a diagnosis of hemorrhagic DM detachment were reviewed for demographic data, clinical findings and treatment applied.
Five patients with hemorrhagic DM detachment were included in this case series. They all had different causes, namely a massive hemorrhage at the end of a canaloplasty procedure, a needling maneuver, autologous blood injection, Swan syndrome, and frequent eye rubbing. Hematoma evacuation was performed in 4 eyes, 1 of them from under the scleral flap of the deep sclerectomy and 3 of them through a surgical or laser perforation in DM. Air tamponade was done in most of these cases. One of these cases required transcorneal suture fixation. One case was observed expectantly. All cases successfully recovered but peripheral corneal stain was persistent in 2 cases.
Hemorrhagic DM detachment is a rare but potential vision-threatening complication in glaucoma surgery. Different mechanisms may cause the bleeding and there are several techniques available to approach this complication. Pre-Descemet hematoma should be drained to avoid permanent corneal stain and air/gas tamponade may help to prevent recurrences.
描述青光眼手术中5例具有不同病因、机制及治疗方法的出血性Descemet膜（DM）脱离病例。
回顾接受非穿透性青光眼手术且诊断为出血性DM脱离患者的临床记录，获取人口统计学数据、临床检查结果及所采用的治疗方法。
本病例系列纳入5例出血性DM脱离患者。其病因各不相同，分别为巩膜环扎术结束时的大量出血、针刺操作、自体血注射、斯旺综合征及频繁揉眼。4只眼进行了血肿清除，其中1只眼通过深层巩膜切除术的巩膜瓣下清除，3只眼通过在DM上进行手术或激光穿孔清除。多数病例进行了空气填塞。其中1例需要经角膜缝线固定。1例采用观察等待。所有病例均成功恢复，但2例周边角膜染色持续存在。
出血性DM脱离是青光眼手术中一种罕见但可能威胁视力的并发症。不同机制可导致出血，针对该并发症有多种处理技术。前弹力层下血肿应予以引流以避免永久性角膜染色，空气/气体填塞可能有助于预防复发。
