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Klin Monbl Augenheilkd 2014; 231(4): 348-350
DOI: 10.1055/s-0034-1368273
Kasuistik
Georg Thieme Verlag KG Stuttgart · New York

Hemorrhagic Descemet Membrane Detachment after Classic Canaloplasty

Hämorrhagische Descemet-Membran-Abhebung bei der klassischen Kanaloplastik
L. M. Brandao
Department of Ophthalmology, University of Basel, Basel, Switzerland (Chairman: Josef Flammer)
,
S. Orgul
Department of Ophthalmology, University of Basel, Basel, Switzerland (Chairman: Josef Flammer)
,
M. C. Grieshaber
Department of Ophthalmology, University of Basel, Basel, Switzerland (Chairman: Josef Flammer)
› Author Affiliations
Further Information

Publication History

received 04 September 2013

accepted 01 January 2014

Publication Date:
25 April 2014 (online)

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Abstract

Purpose: Canaloplasty is a safe and effective alternative in glaucoma surgery, avoiding the risk for hypotony and bleb-related complications. Two cases of hemorrhagic Descemet membrane detachment (DMD) after canaloplasty are reported in patients who did not have previous surgery. Results: Two patients with primary open-angle glaucoma underwent canaloplasty because of medically uncontrolled intraocular pressure (IOP). Canaloplasty was performed using a flexible microcatheter, viscoelastic material and a tensioning suture. The day after surgery, hemorrhagic DMD was observed in the inferior quadrants in both patients on slit-lamp biomicroscopy. Therapy: For the size and location (occlusion of the visual axis), aspiration of blood and descemetopexy with air tamponade were performed promptly. In both cases, a small translucent scar remained. Conclusions: Circumferential cannulation and viscodilation of the Schlemm canal increases the risk for DMD, which may be aggravated by blood reflux resulting from the tensioning suture and low postoperative IOP. Surgeons should be aware of this specific and potentially sight-threatening complication in classic canaloplasty. Immediate intervention is recommended for good visual prognosis.

Zusammenfassung

Hintergrund: Die Kanaloplastik ist eine sichere und wirksame Alternative in der Glaukomchirurgie zur Vermeidung von Hypotonie und Filterkissenproblemen. Anamnese und Befund: Zwei Patienten mit primärem Offenwinkelglaukom hatten eine Kanaloplastik wegen medikamentös nicht beherrschbarem Intraokulardruck (IOD). Die Kanaloplastik wurde mittels flexiblem Mikrokatheter, Viskoelastikum und Spannungsfaden durchgeführt. Am 1. postoperativen Tag zeigte sich bei beiden Patienten eine hämorrhagische Descemet-Membran-Abhebung (DMA) im unteren Quadranten bei der Spaltlampenuntersuchung. Therapie und Verlauf: Aufgrund der Größe und Lokalisation mit Visuseinschränkung wurde das Blut umgehend abgesaugt und eine Descemetopexie mit Luft durchgeführt. In beiden Fällen zeigte sich eine kleine transparente Narbe im Verlauf. Schlussfolgerungen: Zirkumferente Viskoerweiterung und Fadenspannung des Schlemm-Kanals kann das Risiko einer DMA erhöhen, kompliziert durch Refluxblut bei tiefem IOD. Chirurgen sollten diese Kanaloplastik-spezifische und potenziell visusbedrohende Komplikation kennen. Eine unverzügliche Intervention ist für eine gute Visusprognose von Vorteil.

Key words

canaloplasty - corneal hematoma - Descemetʼs membrane detachment - descemetopexy - Schlemmʼs canal - viscodilation

Schlüsselwörter

Kanaloplastik - Hornhauthämatom - Descemet-Membran-Abhebung - Pneumodescemetopexie - Schlemm-Kanal - Viskodilation
 

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