The role of Descemet's membrane in the pathogeny of corneal edema following anterior segment surgery

Objective:

To find relevant factors in the pathogeny of postoperative corneal edema in post-cataract surgery and post-keratoplasty cases, through the study of histopathological findings in order to see what can be done to avoid successive keratoplasties.

Methods:

Retrospective descriptive study of histopathological findings in postoperative corneal edema cases. Tissues were obtained from penetrating keratoplasty in the period between september 2009 and august 2013. A medical record review was conducted primarily looking for information about previous surgeries.

Results:

Seventy corneal buttons were included, out of which 34 were from male patients and 36 were from female patients. The mean age was 63.1±17.20 (mean ± SD) years. Most of cases were corneal failure after keratoplasty (71.43%). The main change found in endothelium was cellular rarefaction (58 cases), and it was also the most common histopathological change. Changes in integrity predominated in Descemet's membrane (53 cases), whether in the form of rupture, isolated detachment or detachment associated with rupture. Endothelial changes associated with the absence in Descemet's membrane integrity were frequent.

Conclusion:

Descemet's membrane detachment is a frequent histopathological finding in postoperative corneal edema cases studied, thus it should be considered an important factor in the pathogeny of such cases. This change should be carefully researched in the postoperative period in order to be diagnosed and treated early, possibly avoiding many keratoplasty indications.

Descemet membrane; Corneal edema/etiology; Corneal edema/pathology; Keratoplasty