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| PHOTO ESSAY |
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| Year : 2022 | Volume
: 60
| Issue : 4 | Page : 323-324 |
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Is it a leech? Is it a slug? It's a descemet's membrane tear!
Shreesha K Kodavoor1, B Soundarya2, Ramamurthy Dandapani3
1 Cornea Services, The Eye Foundation, Coimbatore, Tamil Nadu, India
2 Cornea, Refractive and Cataract Surgery, The Eye Foundation, Coimbatore, Tamil Nadu, India
3 Refractive and Cataract Surgery, The Eye Foundation, Coimbatore, Tamil Nadu, India
| Date of Submission | 07-Feb-2022 |
| Date of Decision | 01-Aug-2022 |
| Date of Acceptance | 09-Aug-2022 |
| Date of Web Publication | 19-Dec-2022 |
Correspondence Address:
Shreesha K Kodavoor
The Eye Foundation, 582, DiwanBahadur Road, R.S. Puram, Coimbatore - 641 002, Tamil Nadu
India
 Source of Support: None, Conflict of Interest: None
DOI: 10.4103/tjosr.tjosr_20_22
A report of a 66-year-old male with keratoconus presenting with an acute hydrops. The patient was managed with intracameral C3F8 gas injection. On postoperative follow-up, slit lamp imaging showed a large central Descemet's membrane tear taking the appearance of a leech, with such well-defined tears in cases of acute hydrops being a rare entity to image on a slit lamp.
Keywords: Acute hydrops, Descemet's membrane tear, keratoconus
How to cite this article:
Kodavoor SK, Soundarya B, Dandapani R. Is it a leech? Is it a slug? It's a descemet's membrane tear!. TNOA J Ophthalmic Sci Res 2022;60:323-4 |
| Photo Essay | |  |
A 66-year-old male presented with complaints of gradually progressive blurring of vision in the right eye for 5 years, followed by a sudden drop in vision, redness, watering, pain, and photophobia for 2 days. Visual acuity of the right eye was counting fingers close to face. Slit lamp examination [Figure 1] and anterior segment Optical Coherence Tomography (OCT) revealed features of acute hydrops in the right eye. He underwent intracameral 14% C3F8 gas injection.
Postoperatively (day 5), gas bubble was in situ with a large Descemet's membrane (DM) tear visible on slit lamp examination, the appearance of which simulates a leech. The tear was extending from 2 mm from the limbus at 8'o clock position up to 1'o clock position, passing through the pupillary centre [Figure 2]a and [Figure 2]b. At 6 weeks follow-up, he had stromal scarring [Figure 3] with Anterior Segment Optical Coherence Tomography (AS-OCT) revealing a compact cornea with reabsorption of intrastromal fluid. He underwent penetrating keratoplasty after 3 months. | Figure 2: Slit lamp image of postoperative day 5 with gas bubble in situ with well-defined Descemet's membrane tear (a) low magnification (b) high magnification
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 | Figure 3: Slit lamp image showing corneal scarring at postoperative 6 weeks
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Hydrops in cases of Keratoconus were characterised by a tear in the DM. The ends of the torn membrane tend to rollaway leading to a gap. This separation paves the way for the aqueous from the anterior chamber to enter into the corneal stroma, thus, leading to oedema.[1],[2] The purpose of intracameral injection of gas is to reduce the duration of corneal oedema. This is achieved by preventing entry of aqueous into the stroma by the gas acting as a tamponade and may also unroll the torn edges of the DM.[1],[3],[4]
Although postoperative DM detachments can be visualised on slit lamp, such well-defined tears following acute hydrops are a rare entity to image on a slit lamp. These images presented here portray a rare presentation of the DM tear in the form of a leech, following intracameral gas injection.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
| References | | |
| 1. | Tuift SJ, Gregory WM, Buckley RJ. Acute corneal hydrops in keratoconus. Ophthalmology 1994;101:1738-44.  |
| 2. | Sharma N, Mannan R, Jhanji V, Agarwal T, Pruthi A, Titiyal JS, et al. Ultrasound biomicroscopy-guided assessment of acute corneal hydrops. Ophthalmology 2011;118:2166-71. |
| 3. | Sharma N, Maharana PK, Jhanji V, Vajpayee RB. Management of acute corneal hydrops in ectatic corneal disorders.CurrOpinOphthalmol 2012;23:317-23. |
| 4. | Basu S, Vaddavalli PK, Ramappa M, Shah S, Murthy SI, Sangwan VS. Intracameralperfluoropropane gas in the treatment of acute corneal hydrops. Ophthalmology 2011;118:934-9. |
[Figure 1], [Figure 2], [Figure 3]
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