Pieramici D, Green W R, Stark W J
Eye Pathology Laboratory, Johns Hopkins University Medical Institutions, Baltimore, MD.
Ophthalmic Surg. 1994 Apr;25(4):226-31.
We describe a case of accidental injection of sodium hyaluronate (Healon) anterior to Descemet's membrane that caused the membrane to become almost completely detached. The patient eventually underwent penetrating keratoplasty, permitting histopathologic study of the detachment. Sodium hyaluronate globules in the space between the posterior stroma and Descemet's membrane were demonstrated by light and electron microscopy. In addition, 111 consecutive cases of Descemet's membrane detachment identified pathologically were reviewed to identify potential predisposing risk factors and determine corneal pathologic changes. A history of previous intraocular surgery was present in 89 (80%) of the cases; cataract surgery, the most common, had occurred in 52 (58%). Frequent associated corneal pathologic findings were bullous keratopathy in 48 (43%) of the specimens, and scarring and vascularization in 33 (29.7%). In one case that was identified and studied histopathologically, a 90% detachment of Descemet's membrane was noted clinically following the reformation of the anterior chamber with sodium hyaluronate. We conclude that in the cases of Descemet's membrane detachment that came to pathologic examination, intraocular surgery was a major predisposing risk factor. Corneal pathologic changes, which were common, possibly masked the clinical diagnosis of Descemet's membrane detachment in some cases.
我们描述了1例在Descemet膜前意外注射透明质酸钠（Healon）导致该膜几乎完全脱离的病例。患者最终接受了穿透性角膜移植术，从而能够对脱离情况进行组织病理学研究。通过光学显微镜和电子显微镜证实了后基质与Descemet膜之间存在透明质酸钠小球。此外，回顾了连续111例经病理确诊的Descemet膜脱离病例，以确定潜在的诱发危险因素并确定角膜的病理变化。89例（80%）病例有既往眼内手术史；最常见的是白内障手术，有52例（58%）。常见的相关角膜病理表现为48例（43%）标本出现大泡性角膜病变，33例（29.7%）出现瘢痕形成和血管化。在1例经组织病理学鉴定和研究的病例中，在前房用透明质酸钠重建后，临床发现Descemet膜脱离90%。我们得出结论，在进行病理检查的Descemet膜脱离病例中，眼内手术是主要的诱发危险因素。常见的角膜病理变化在某些情况下可能掩盖了Descemet膜脱离的临床诊断。
