Descemet stripping only and ripasudil for the treatment of traumatic Descemet’s membrane ruptures

Abstract

Purpose Descemet´s membrane ruptures (with a discontinuation of Descemet´s membrane and double detached coiled edges) in the context of complicated anterior segment surgery have rarely been described and its management can be challenging. We report a modified Descemet stripping only (DSO) technique associated with ripasudil drops to treat these cases when other techniques fail. Methods We describe two cases of large Descemet´s membrane detachments associated with Descemet´s ruptures after cataract surgery that did not respond to two SF6 intracameral injections. As the detached Descemet's membrane and coiled edges might have prevented endothelial cell migration, we decided to perform a modified DSO with post-operative ripasudil drops to promote corneal clearance. Results Both cases improved significantly in unaided and best corrected visual acuity (BCVA), corneal clearance and pachymetry, avoiding the need for an endothelial keratoplasty. Endothelial cells were observed on specular microscopy within the area of the descemetorhexis. Conclusion DSO with ripasudil drops might be a valuable tool to recover corneal clearance and avoid endothelial keratoplasty in complex Descemet´s membrane detachments with ruptures that do not respond to other treatments.

ROCK Inhibitors in Corneal Diseases and Glaucoma—A Comprehensive Review of These Emerging Drugs

“…Cataract or anterior segment surgeries are known to be associated with a risk of postoperative corneal oedema due to endothelial cell damage. Studies have shown that administering ripasudil in the post-operative period has a protective effect on endothelial cell density [38], and may improve visual recovery after complicated procedures [39,40]. In both Descemet's Stripping Automated Endothelial Keratoplasty (DSAEK) and penetrating keratoplasty corneal grafts that failed to clear with conservative management, vision can be rescued with ripasudil therapy [41].…”

Role of descemet's stripping without keratoplasty in management of endothelial disease

“…DSO combined with postoperative topical ROCKi (ripasudil) has also been reported to be effective in managing DM rupture [30 ▪ ]. Fernandez Lopez et al [30 ▪ ] described two cases where a modified DSO was performed in combination with postoperative ripasudil to treat corneal oedema following iatrogenic DM rupture occurring during cataract surgery.…”

“…DSO combined with postoperative topical ROCKi (ripasudil) has also been reported to be effective in managing DM rupture [30 ▪ ]. Fernandez Lopez et al [30 ▪ ] described two cases where a modified DSO was performed in combination with postoperative ripasudil to treat corneal oedema following iatrogenic DM rupture occurring during cataract surgery. In both cases corneal clarity was not achieved until the ruptured DM was removed during the subsequent DSO, possibly due to the scrolled DM acting as a barrier to cell migration.…”