Department of Ophthalmology, Cornea and Ocular Surface Services, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India.
Department of Ophthalmology, Aravind Eye Hospital and Postgraduate Training Centre, Tirunelveli, Tamil Nadu, India.
Indian J Ophthalmol. 2024 Nov 1;72(11):1560-1568. doi: 10.4103/IJO.IJO_877_24. Epub 2024 Aug 14.
The Descemet membrane (DM) is the basement membrane of corneal endothelial cells, which are responsible for maintaining corneal transparency. DM detachment (DMD) can occur due to various reasons, with the most common etiology being post-surgical. Older age, blunt instruments, and faulty surgical technique predispose to the intraoperative or postoperative occurrence of DMD, and one should have a high index of suspicion for DMD in cases with unexplained or an atypical pattern of corneal edema after surgery. Prompt intervention for DMD management is imperative to effect early visual rehabilitation, decrease corneal morbidity, and avoid permanent damage leading to scarring of the cornea. Various classifications of DMD and management protocols have been described. Anterior-segment optical coherence tomography (AS-OCT) imaging is the most effective imaging to detect DMD and quantify its extent. Desmetopexy with air/gas is the initial treatment of choice and could be aided by suture fixation. Non-responsive cases might need endothelial keratoplasty.
Descemet 膜（DM）是角膜内皮细胞的基底膜，负责维持角膜透明性。DM 脱离（DMD）可由多种原因引起，最常见的病因是手术后。年龄较大、钝性器械和错误的手术技术易导致术中或术后发生 DMD，对于手术后出现不明原因或非典型角膜水肿的病例，应高度怀疑 DMD。及时干预 DMD 管理对于早期视力康复、减少角膜发病率和避免导致角膜瘢痕形成的永久性损伤至关重要。已经描述了各种 DMD 分类和管理方案。前节光学相干断层扫描（AS-OCT）成像术是检测 DMD 并定量其程度的最有效成像术。Desmetopexy 联合空气/气体是首选的初始治疗方法，并可通过缝线固定辅助。无反应的病例可能需要进行内皮角膜移植术。
