Descemet Membrane Folds Workup

Author: Robert H Graham, MD; Chief Editor: Hampton Roy Sr, MD more...

Updated: Feb 14, 2012

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Laboratory Studies
Imaging Studies
Other Tests
Procedures
Histologic Findings
Staging
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References

Laboratory Studies

Elucidate and treat the underlying condition causing the inflammation. Most of the ophthalmic evaluation is clinical. Consider herpes simplex for epithelial infection or stromal infiltrations, which may need impression cytology studies.

B-scan ultrasound can be considered if the view to the posterior pole is obscured.
Ultrasound biomicroscopy (UBM) can be helpful to identify foreign bodies in the angle, iris, or anterior sclera, especially after trauma. UBM may be helpful if the view to the anterior chamber angle is obscured.

Gonioscopy may be helpful to reveal retained lens fragments in the anterior chamber angle.

Surgery may be necessary either to replace the cornea if the endothelium is not functional or to treat the underlying cause of inflammation (eg, retinal detachment, retained lens fragments, intraocular foreign body).

Histologic Findings

Corneal donor button from penetrating keratoplasty shows corneal stromal edema with fixed folds of the Descemet membrane.

Staging

Staging is not standardized but can be described as 1 to 4 with 1+ implying mild and 4+ implying severe folds.

Proceed to Treatment & Management

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

American Academy of Ophthalmology. External disease and cornea. In: Basic and Clinical Science Course, Section 8. 2006-2007.
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].
Wilson FM. Slit-lamp biomicroscopy. In: Practical Ophthalmology. 4^th ed. 1996:213-229.
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].
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].
Thomson Reuters. Physicians Desk Reference. 63^rd ed. 2009.
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].
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].
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].

Descemet membrane folds after surgery.

Diffuse illumination showing Descemet membrane folds after surgery.

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Descemet Membrane Folds Workup

Laboratory Studies

Imaging Studies

Other Tests

Procedures

Histologic Findings

Staging