Yang Xiao, Chen Yuanzhi, Yu Guangwei, Dang Guangfu
Department of Ophthalmology, Jinan Mingshui Eye Hospital,Zhangqiu, Jinan, 250200, China.
Department of Ophthalmology, Qianfoshan Hospital Affiliated with Shandong University, Jinan, 250014, China.
Am J Ophthalmol Case Rep. 2022 Jan 20;25:101276. doi: 10.1016/j.ajoc.2022.101276. eCollection 2022 Mar.
We report a rare case of recurrent Descemet's membrane detachment (DMD) post-trabeculectomy which was resolved spontaneously without surgical intervention.
A 66-year-old patient with a history of acute angle closure glaucoma in his right eye presented to our hospital. The intraocular pressure (IOP) of his right was 40 mm Hg, and the visual acuity was10/20. After trabeculectomy of the affected eye, a severe Descemet's membrane detachment was found by AS-OCT. Part of Descemet's membrane was lying in front of the iris and lens. Surgical repair was performed, and viscoelastics and sterile air were injected into the anterior chamber to return the detached Descemet's membrane. AS-OCT showed that the DMD was successfully resolved. However, on the 7th day of follow-up, the DMD was detached again as seen on AS-OCT images. The patient refused reoperation to repair the DMD. Six months later, the patient visited our hospital again, and, interestingly, the DMD was completely resolved spontaneously without reoperation.
Descemet's membrane is the basement membrane that lies between the stroma and the endothelial layer of the cornea. Minor DMD may be resolved spontaneously within a period of time without surgery, but large DMD is difficult to recover spontaneously. We believe that this is a rare case with spontaneous recovery of extensive DMD after trabeculectomy. But, despite all this, we still remain of the view that DMD should be treated immediately once it occurs.
我们报告一例小梁切除术后罕见的复发性后弹力层脱离（DMD）病例，该病例未经手术干预而自发缓解。
一名66岁右眼有急性闭角型青光眼病史的患者前来我院就诊。其右眼眼压为40 mmHg，视力为10/20。患眼小梁切除术后，经眼前节光学相干断层扫描（AS-OCT）发现严重的后弹力层脱离。部分后弹力层位于虹膜和晶状体前方。进行了手术修复，并向前房注入粘弹剂和无菌空气以使脱离的后弹力层复位。AS-OCT显示DMD成功复位。然而，在随访的第7天，AS-OCT图像显示DMD再次脱离。患者拒绝再次手术修复DMD。6个月后，患者再次来我院就诊，有趣的是，DMD未经再次手术而完全自发缓解。
后弹力层是位于角膜基质层和内皮层之间的基底膜。轻度DMD可能在一段时间内自发缓解而无需手术，但严重的DMD难以自发恢复。我们认为这是一例小梁切除术后广泛DMD自发恢复的罕见病例。但是，尽管如此，我们仍然认为DMD一旦发生就应立即治疗。
