PURPOSE: To describe a case of hemorrhagic Descemet membrane detachment after canaloplasty and to discuss its management using alteplase, a tissue plasminogen activator (TPA). METHODS: Interventional case report. RESULTS: A 60-year-old woman with advanced pseudoexfoliation glaucoma developed severe hemorrhagic Descemet detachment after canaloplasty. Initial anterior chamber and pre-Descemet washout yielded no improvement. On the fifth postoperative day, the patient received a novel pre-Descemet treatment using a TPA with an anterior chamber air bubble. The intracorneal blood clot quickly dissolved intraoperatively with the Descemet membrane almost completely reattached on postoperative day 1. CONCLUSIONS: Hemorrhagic Descemet detachment is a rare and serious complication of canaloplasty. The use of pre-Descemet TPA dissolves the intracorneal blood clot and helps reattach Descemet membrane, allowing quick rehabilitation of patient's vision and preserving integrity of the cornea.
PURPOSE: To describe a case of hemorrhagic Descemet membrane detachment after canaloplasty and to discuss its management using alteplase, a tissue plasminogen activator (TPA). METHODS: Interventional case report. RESULTS: A 60-year-old woman with advanced pseudoexfoliation glaucoma developed severe hemorrhagic Descemet detachment after canaloplasty. Initial anterior chamber and pre-Descemet washout yielded no improvement. On the fifth postoperative day, the patient received a novel pre-Descemet treatment using a TPA with an anterior chamber air bubble. The intracorneal blood clot quickly dissolved intraoperatively with the Descemet membrane almost completely reattached on postoperative day 1. CONCLUSIONS:Hemorrhagic Descemet detachment is a rare and serious complication of canaloplasty. The use of pre-Descemet TPA dissolves the intracorneal blood clot and helps reattach Descemet membrane, allowing quick rehabilitation of patient's vision and preserving integrity of the cornea.
Authors: Juan Carlos Izquierdo Villavicencio; Josefina A Mejías Smith; Laura A Cañola Ramírez; Natalia Agudelo Arbelaez; Bárbara Rubio Lastra Journal: Case Rep Ophthalmol Med Date: 2019-04-21