Intracorneal inclusion of high-molecular-weight sodium hyaluronate following detachment of Descemet's membrane during viscocanalostomy.
OBJECTIVE
Viscocanalostomy in accordance with Stegmann's technique is a new surgical option in the treatment of glaucoma. There are few reports available describing the specific complications of viscocanalostomy. We report a case of intracorneal inclusion of high-molecular-weight sodium hyaluronate following viscocanalostomy.


METHODS
A 66-year-old man with uncontrolled primary open angle glaucoma of his right eye and a history of argon laser trabeculoplasty underwent viscocanalostomy in accordance with Stegmann's technique. During the filling of Schlemm's canal, a limited lysis of Descemet's membrane advanced centrally in the clear cornea adjacent to the site of canalostomy forming an intracorneal bubble of high-molecular-weight sodium hyaluronate. Postsurgical slit-lamp biomicroscopy showed an intracorneal clear bubble within the corneal periphery without evidence of adjacent corneal edema and with no contact between the corneal endothelium and the iris. Follow-up examinations determined that the appearance of the corneal inclusion, essentially, was unchanged, with only a slight tendency of resorption. No signs of corneal scarring or endothelial decompensation could be noted.


CONCLUSIONS
To date, we could not determine a significant corneal damage in conjunction with the described complication. However, it is difficult to predict the long-term clinical course of our patient. Corneal decompensation as a result of possible endothelial toxicity of high-molecular weight sodium hyaluronate as well as spontaneous absorption seem possible.
Department of Ophthalmology, University of Cologne, Germany. aia18@uni-koeln.de
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C
Lüke
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Dietlein
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Jacobi
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Konen
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Krieglstein
D000368:Aged; D015715:Corneal Edema / Q000139:chemically induced* / Q000473:pathology; D003886:Descemet Membrane / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery; D018463:Filtering Surgery / Q000009:adverse effects*; D005902:Glaucoma, Open-Angle / Q000473:pathology / Q000601:surgery*; D006801:Humans; D006820:Hyaluronic Acid / Q000008:administration & dosage / Q000009:adverse effects*; D007267:Injections; D007429:Intraocular Pressure; D008297:Male; D013524:Surgical Flaps; D014463:Ultrasonography; D014792:Visual Acuity
D006820:Hyaluronic Acid