Stripping of Descemet's membrane while refilling the anterior chamber.

A 67-year-old man underwent a trabeculectomy for pseudo-exfoliative glaucoma. The postoperative course was complicated by overfiltration with hypotony and a flat anterior chamber (AC) with lens touch. While the AC chamber was refilled at the slitlamp with a viscoelastic (Healon), stripping of Descemet’s membrane was observed. The patient was referred to our department. Slitlamp examination showed a diffuse filtering bleb (Seidel negative), a clear cornea, stripping of Descemet’s membrane (except superiorly) with Healon trapped between Descemet and corneal stroma (figures 1 and 2), a flat AC with Descemet-lens and Descemet-iris touch, pharmacological mydriasis, and a choroidal detachment on fundoscopy. The intraocular pressure (IOP) was 6 mmHg. In order to reposition Descemet’s membrane, a small hole was first made in the membrane opposite the original corneal paracentesis infero-temporaly using a 15° knife. Healon was then injected into the AC via a second paracentesis supero-nasally in an attempt to flatten Descemet’s membrane by squeezing out the viscoelastic trapped in front of it. The trapped Healon could escape via the infero-temporal corneal paracentesis (out of the eye) and via the hole made in Descemet’s membrane (into the AC). Balanced Salt Solution (BSS) was then used to irrigate and aspirate the residual Healon. At the end, non-expandable 20% Sulfur hexafluoride (SF-6) gas was injected into the AC in order to compress Descemet’s membrane against the stroma. Up to this moment the cornea remained clear, but once the Healon was removed from the pocket between Descemet and stroma, the cornea gradually became oedematous.