Descemet Membrane Folds Clinical Presentation

  • Author: Robert H Graham, MD; Chief Editor: Hampton Roy Sr, MD   more...
 
Updated: Feb 14, 2012
 

History

  • Pain - External-type pain alleviated by topical anesthesia
  • Blurry vision - Mild to moderate if only stromal edema; moderate to severe if epithelial edema too; can severely affect vision
  • Foreign body sensation – External symptoms alleviated by topical anesthetic
  • Tearing due to external symptoms
  • Eyelid swelling if corneal edema is severe
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Physical

  • Descemet folds are directly visible with slit lamp biomicroscopy using direct focal illumination, specular reflection, and retroillumination.[3]
  • Descemet folds are associated with corneal edema due to endothelial dysfunction from infections, from infiltrations, or following surgery.
  • Descemet folds also are associated with corneal inflammation due to infections or infiltrations or following surgery.
  • Descemet folds also are associated with anterior chamber inflammation visible by direct focal illumination.
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Causes

  • Inflammation due to corneal or ocular infection
  • Inflammation after surgery; normal postoperative inflammation or exuberant inflammatory response can be due to complicated surgery, retained lens fragments, retinal detachment, or endophthalmitis.
  • Inflammatory conditions, such as blepharitis, phlyctenulosis, episcleritis, and scleritis
  • Trauma or injury, such as blunt trauma or acidic/alkaline chemical injury
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Contributor Information and Disclosures
Author

Robert H Graham, MD  Senior Associate Consultant, Department of Ophthalmology, Mayo Clinic, Scottsdale, Arizona

Robert H Graham, MD is a member of the following medical societies: American Academy of Ophthalmology, American Medical Association, and Arizona Ophthalmological Society

Disclosure: WebMD/eMedicine Salary Employment

Coauthor(s)

Magdalena F Shuler, MD, PhD  Consulting Staff, Retina Specialists, PA

Magdalena F Shuler, MD, PhD is a member of the following medical societies: American Academy of Ophthalmology, American Society of Cataract and Refractive Surgery, Florida Medical Association, and Phi Beta Kappa

Disclosure: Nothing to disclose.

Specialty Editor Board

Fernando H Murillo-Lopez, MD  Senior Surgeon, Unidad Privada de Oftalmologia CEMES

Fernando H Murillo-Lopez, MD is a member of the following medical societies: American Academy of Ophthalmology

Disclosure: Nothing to disclose.

Simon K Law, MD, PharmD  Associate Professor of Ophthalmology, Jules Stein Eye Institute, University of California, Los Angeles, David Geffen School of Medicine

Simon K Law, MD, PharmD is a member of the following medical societies: American Academy of Ophthalmology, American Glaucoma Society, and Association for Research in Vision and Ophthalmology

Disclosure: Nothing to disclose.

Christopher J Rapuano, MD  Professor, Department of Ophthalmology, Jefferson Medical College of Thomas Jefferson University; Director of the Cornea Service, Co-Director of Refractive Surgery Department, Wills Eye Institute

Christopher J Rapuano, MD is a member of the following medical societies: American Academy of Ophthalmology, American Society of Cataract and Refractive Surgery, Contact Lens Association of Ophthalmologists, Cornea Society, Eye Bank Association of America, International Society of Refractive Surgery, and Pan-American Association of Ophthalmology

Disclosure: Allergan Honoraria Speaking and teaching; Allergan Consulting fee Consulting; Alcon Honoraria Speaking and teaching; RPS Ownership interest Other; EyeGate Pharma Consulting fee Consulting; Bausch & Lomb Honoraria Speaking and teaching; Bausch & Lomb Consulting; Merck Honoraria Speaking and teaching

Lance L Brown, OD, MD  Ophthalmologist, Affiliated With Freeman Hospital and St John's Hospital, Regional Eye Center, Joplin, Missouri

Disclosure: Nothing to disclose.

Chief Editor

Hampton Roy Sr, MD  Associate Clinical Professor, Department of Ophthalmology, University of Arkansas for Medical Sciences

Hampton Roy Sr, MD is a member of the following medical societies: American Academy of Ophthalmology, American College of Surgeons, and Pan-American Association of Ophthalmology

Disclosure: Nothing to disclose.

References

  1. American Academy of Ophthalmology. External disease and cornea. In: Basic and Clinical Science Course, Section 8. 2006-2007.

  2. Obata H, Tsuru T. Corneal wound healing from the perspective of keratoplasty specimens with special reference to the function of the Bowman layer and Descemet membrane. Cornea. Oct 2007;26(9 Suppl 1):S82-9. [Medline].

  3. Wilson FM. Slit-lamp biomicroscopy. In: Practical Ophthalmology. 4th ed. 1996:213-229.

  4. Espana EM, Huang B. Confocal microscopy study of donor-recipient interface after Descemet's stripping with endothelial keratoplasty. Br J Ophthalmol. Jul 2010;94(7):903-8. [Medline].

  5. Dirisamer M, van Dijk K, Dapena I, Ham L, Oganesyan O, Frank LE, et al. Prevention and Management of Graft Detachment in Descemet Membrane Endothelial Keratoplasty. Arch Ophthalmol. Nov 14 2011;[Medline].

  6. Thomson Reuters. Physicians Desk Reference. 63rd ed. 2009.

  7. Scuderi B, Driussi GB, Chizzolini M, Salvetat ML, Beltrame G. Effectiveness and tolerance of piroxicam 0.5% and diclofenac sodium 0.1% in controlling inflammation after cataract surgery. Eur J Ophthalmol. Jul 2003;13(6):536-40. [Medline].

  8. Denion E, Dalens PH, Huguet P, Petitbon J, Gerard M. Radial Descemet's membrane folds as a sign of pterygium traction. Eye. Jul 2005;19(7):800-1. [Medline].

  9. Melles GR, Ong TS, Ververs B, van der Wees J. Preliminary clinical results of Descemet membrane endothelial keratoplasty. Am J Ophthalmol. Feb 2008;145(2):222-227. [Medline].

 
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Descemet membrane folds after surgery.
Diffuse illumination showing Descemet membrane folds after surgery.
 
 
 
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