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Confocal corneal in-vivo microscopy in patients having a rhexis of Descemets membrane G. Altmann, J. Tympner, R. KuckelkornIntroduction: Stripping of Descemets membrane is a rare complication of cataract surgery. Even an accidental rhexis of this membrane can occur in cases of primarily induced detachment of Descemets membrane and poor visibility. This is an example of an extreme trauma to Descemets mem-brane and the endothelium. Hence, structural changes of corneas having sustained such kind of rhexis were analysed using confocal microscopy.
Methods: Two patients underwent cataract surgery elsewhere complicated by rhexis of Descemets membrane 8 months and 5 years prior to presen-ting in our cornea clinic. After initial corneal decompensation transparency had improved markedly by the time of admission. Both patients were studied using the confocal, slit-scanning videomicroscope "Microphthal" (Fa. Hund, Wetzlar, Germany).
Results: Stromal alterations such as discrete edema and highly reflective spots representing detritus are seen. In the posterior stroma activated cells of keratocytic and probably even endothelial origin are noticed. Further-more, a highly reflective homogenous layer almost always covered by endothelium is detectable at the posterior aspect of the stroma. However, endothelial cell borders are quite ill-defined.
Discussion: Even five years after trauma typical stromal alterations could be observed. Regained corneal clarity is due to the re-formed continuous endothelial cell layer. However, the intercellular substance is not optimal, yet. Subsequently, a pseudo-Descemets membrane is formed, being rela-tively thick and highly reflective, in order to repair the initial defect. On the whole, confocal micoscopy reveals the corneal ability to repair large traumatic defects of Descemets membrane and the endothelium.
Dept. of Ophthalmology, RWTH Aachen, Pauwelsstr. 30, D-52074 Aachen