A new clinico-tomographic classification and management algorithm for Descemet's membrane detachment.
OBJECTIVE
To propose a new clinico-tomographic classification of Descemet's detachment (DD).


METHODS
Interventional case series of 35 eyes with DD were clinico-tomographically classified as: (1)Rhegmatogenous DD (RDD)-lax, free floating DM secondary to DM tear/hole/dialysis; ASOCT showing undulating linear signal with total length equalling overlying stromal arc length. (2) Tractional DD (TDD)-foreshortened, taut DM with tractional/fibrotic component; ASOCT showing detached DM chord length less than overlying stromal arc length. (3) Bullous DD (BDD)-bulge of DM into AC in absence of DM break or needle puncture break too small to allow egress of contents; ASOCT showing convex signal. (4) Complex DD (CDD)-Complex variants and combinations seen clinically and on ASOCT.


RESULTS
RDD was most common (n=23), 19 were RDD with tear (post-surgical) treated by observation(n=3)/pneumodescemetopexy(n=16), 2 were RDD with hole due to inadvertent DM perforation in deep anterior lamellar keratoplasty treated by pneumodescemetopexy and fibrin glue, 2 were RDD with dialysis post-Descemetorhexis in Descemet's Membrane Endothelial Keratoplasty, not requiring treatment. TDD (n=4) was treated by relaxing Descemetotomy (n=3) or EK (n=1, poor endothelium); BDD (n=3) with two improving spontaneously; CDD (n=5) treated by refloatation with air (n=3)/EK (n=1)/penetrating keratoplasty (n=1).


CONCLUSIONS
Treatment and prognosis of DD varies based on etio-morphology. This classification allows systematic approach for diagnosis, management and prognostication.
Dr. Agarwal's Eye Hospital and Eye Research Centre, 19 Cathedral Road, Chennai 600 086, Tamilnadu, India.
Soosan
S
Jacob
Dr. Agarwal's Eye Hospital and Eye Research Centre, 19 Cathedral Road, Chennai 600 086, Tamilnadu, India. Electronic address: dragarwal@vsnl.com.
Amar
A
Agarwal
Dr. Agarwal's Eye Hospital and Eye Research Centre, 19 Cathedral Road, Chennai 600 086, Tamilnadu, India.
Prashaant
P
Chaudhry
Dr. Agarwal's Eye Hospital and Eye Research Centre, 19 Cathedral Road, Chennai 600 086, Tamilnadu, India.
Smita
S
Narasimhan
Dr. Agarwal's Eye Hospital and Eye Research Centre, 19 Cathedral Road, Chennai 600 086, Tamilnadu, India.
Vidya Nair
VN
Chaudhry
D000465:Algorithms; D019090:Case Management / Q000458:organization & administration; D065306:Corneal Injuries / Q000473:pathology* / Q000601:surgery*; D003886:Descemet Membrane / Q000293:injuries* / Q000473:pathology* / Q000601:surgery; D006801:Humans; D013508:Ophthalmologic Surgical Procedures / Q000379:methods; D018579:Patient Selection; D011300:Preoperative Care / Q000379:methods; D041623:Tomography, Optical Coherence / Q000379:methods*; D016896:Treatment Outcome
Bullous Descemet's detachment; Descemet's membrane detachment; Optical coherence tomography; Relaxing Descemetotomy; Rhegmatogenous Descemet's detachment; Tractional Descemet's detachment