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JAMA Ophthalmology Clinical Challenge
January 05, 2017

Hemorrhagic Descemet Membrane Detachment After Canaloplasty

Author Affiliations
  • 1Dean McGee Eye Institute, Oklahoma City, Oklahoma
JAMA Ophthalmol. Published online January 5, 2017. doi:10.1001/jamaophthalmol.2016.2834

A man in his 50s presented with primary open-angle glaucoma and a visually significant cataract, causing a 4-diopter myopic shift. The patient elected to proceed with cataract extraction and a lens implant followed by canaloplasty. The cataract extraction and lens implant went routinely, but during the canaloplasty, a hard-stop obstruction was encountered at the 7-o’clock position during the passage of the illuminated catheter. A viscoelastic material was injected into the Schlemm canal to attempt to break the obstruction. This resulted in a large inferior nasal Descemet membrane detachment. A washout was not performed because of concerns of further exacerbating the detachment or inducing a hemorrhage. The procedure was aborted, a 50% air bubble was injected into the eye, and the physicians recommended that the patient maintain a face-up position. The patient had a persistent Descemet membrane detachment at the 1-day postoperative visit (Figure). By the 1-week postoperative visit, the patient began to develop blood in the interface, which had not resolved by the 1-month postoperative visit with a visual acuity of 20/50 (Figure).

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