‘Descemet’s membrane detachment’: A novel concept in diagnos
Highlights of the study

-Descemet’s membrane (DM) detachment (DMD) is not always the detachment of the DM alone.
-The pre-Descemet’s layer (PDL) often also detaches with the DM.
-The PDL and DM may detach but remain attached to each other (Type 1 detachment).
-The DM may detach by itself (Type 2 detachment) or with PDL but separated from it (Mixed type).
-Recognition of detachment of PDL is important in understanding DMD and its management.

Descemet’s membrane detachment (DMD) has been recognized as a pathology of the posterior cornea, occurring especially after complicated or multiple intraocular surgeries, for close to a hundred years. A study was conducted to examine the optical coherence tomography (OCT) and histological features of Descemet’s membrane detachment (DMD) to ascertain the involvement of the pre-Descemet’s layer (PDL). Clinical, histopathological, and OCT features of forty-one cases with a diagnosis of DMD were studied.

Three types of DMD were identified. Type 1, where the PDL and DM were detached together. Type 2, where only the DM was detached and Mixed, where the PDL and DM were detached but also separated from each other. These were further found to be rhegmatogenous or non-rhegmatogenous depending on the presence of absence of a tear in DM or both layers. Histology confirmed involvement of PDL in all 5 cases and showed it to be infiltrated by cells in 3 of 5 cases.

In conclusion, the PDL is involved in DMD. This fact significantly changes our understanding of DMD and could have implications for management. The detached PDL can be infiltrated with cells. A prospective study in relation to etiology and types of DMD is needed.

Source: https://www.ajo.com/article/S0002-9394(20)30279-8/fulltext?rss=yes