Descemet’s Membrane Injury Post YAG Peripheral Iridotomy

Harsh Kumar; Chirag Mittal; Arushi Puri

doi:doi:10.11648/j.ijovs.20200501.18

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Descemet’s Membrane Injury Post YAG Peripheral Iridotomy

Harsh Kumar, Chirag Mittal, Arushi Puri

Published in International Journal of Ophthalmology & Visual Science (Volume 5, Issue 1)

Received: 10 February 2020 Accepted: 2 March 2020 Published: 6 March 2020

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Abstract

Neodymium: Yittrium - Aluminium-Garnet (Nd YAG) laser iridotomy is one of the most common laser procedures performed in the Asian continent as the proportion of Angle closure glaucoma cases is significant. The Nd YAG iridotomy appears to be a simple outpatient procedure but can result in a number of complications including haemorrhage, cataract formation, dysphotopsia, intraocular pressure elevation and corneal endothelial damage resulting in corneal decompensation at a later date. A forty one year old female patient, a case of Primary Angle Closure Suspect (PACS), who had undergone a Nd YAG laser iridotomy of both the eyes elsewhere presented to us for a second opinion. The anterior segment examination was unremarkable except for the bilateral peripheral Iridotomies. The slit lamp examination revealed three small defects in the temporal cornea at the level of the Descemet’s membrane and posterior stroma overlying the iridotomy in the right eye. A specular microscopy did not reveal any endothelial damage or change in the cell morphology overlying the iridotomy or in other areas. Anterior segment Ocular Coherence Tomography (OCT) demonstrated the exact nature of the injury to the Decemets membrane. To the best of our knowledge, its the first case report in the literature of a Descmet’s membrane injury following a ND-YAG laser iridotomy. It emphasizes the importance of accurate focus on the iris and choosing a quadrant with adequate distance between the iris and the cornea to avoid injury to surrounding structures.

Published in	International Journal of Ophthalmology & Visual Science (Volume 5, Issue 1)
DOI	10.11648/j.ijovs.20200501.18
Page(s)	38-40
Creative Commons	This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.
Copyright	Copyright © The Author(s), 2020. Published by Science Publishing Group

Keywords

Descemet’s Membrane Injury, Yag Laser PI, Laser Complications, Corneal Decompensation

References

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[2]	Foster PJ, Oen FT, Machin D, Ng TP, Devereux JG, Johnson GJ, et al. The Prevalance of glaucoma in Chinese residents of Singapore: A cross- sectional population survey of the Tanjong Pagar district. Arch Ophthalmol. 2000; 118 (8): 1105-1111.
[3]	Razeghinejad MR, Banifatemi M. Ocular biometry in angle closure. J Ophthalmic Vis Res. 2013; 8: 17-24.
[4]	Thomas R, Parikh R, Muliyil J, Kumar RS. Five- year risk of progression of primary angle closure to primary angle closure glaucoma: A population-based study. Acta Ophthalmol Scand. 2003; 81: 480-485.
[5]	Lee JR, Choi JY, Kim YD, Choi J. Laser peripheral iridotomy with iridoplasty in primary angle closure suspect: Anterior chamber analysis by pentacam. Korean J Ophthalmol. 2011; 25: 252-256.
[6]	Boey PY, Singhal S, Perera SA, et al. Conventional and emerging treatments in the management of acute primary angle closure. Clin Ophthalmol. 2012; 6: 417-424.
[7]	Ang LP, Higashihara H, Sotozono C, Shanmuganathan VA, Dua H, Tan DT, et al. Argon laser iridotomy- induced bullous keratopathy a growing problem in Japan. Br J Ophthalmol. 2007; 91: 1613-1615.
[8]	Kataoka T, Zako M, Takeyama M, Ohno-Jinno A, Sugenoya J, Iwaki M. Cooling prevents induction of corneal damage by argon laser peripheral iridotomy. Jpn J Ophthalmol. 2007; 51: 317-324.
[9]	Liang YB, Wang NL, Rong SS, Thomas R. Initial treatment for primary- angle closure glaucoma in China. J Glaucoma. 2015; 24: 469-473.
[10]	Golan S, Levkovitch- Verbin H, Shemesh G, Kurtz S. Anterior chamber bleeding after laser peripheral iridotomy. JAMA Ophthalmol. 2013; 131: 626-629.
[11]	Wang PX, Koh VT, Loon SC. Laser iridotomy and the corneal endothelium: A systemic review. Acta Ophthalmol. 2014; 92: 604-616.
[12]	Kumar H, Mansoori T, Warjri GB, Somarajan BI, Bandil S, Gupta V. Lasers in glaucoma. Indian J Ophthalmol. 2018; 66: 1539-53.
[13]	Jamali H, Jahanian S, Gharebaghi R. Effects of Laser Peripheral Iridotomy on Corneal Endothelial Cell Density and Cell Morphology in Primary Angle Closure Suspect Subjects. J Ophthalmic Vis Res. 2016; 11 (3): 258–262.
[14]	Yana Fu, Wuying Zhou, Wei Li, Xiaolei Lin, Qi Dai. Late-onset descemet membrane detachment and corneal decompensation after laser peripheral iridotomy. Medicine (Baltimore). 2018; 97 (10): e0083
[15]	Marraffa M, Marchini G, Pagliarusco A, Perfetti S, Toscano A, Brunelli C, et al. Ultrasound biomicroscopy and corneal endothelium in Nd: YAG- laser iridotomy. Ophthalmic Surg Lasers. 1995; 26: 519-523.
[16]	Bron AJ, Tripathi RC, Tripathi BJ. Wolff’s Anatomy of the Eye and Orbit. 8^th ed. Spain: Chapman and Hall publishers; 1997.

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APA Style

Harsh Kumar, Chirag Mittal, Arushi Puri. (2020). Descemet’s Membrane Injury Post YAG Peripheral Iridotomy. International Journal of Ophthalmology & Visual Science, 5(1), 38-40. https://doi.org/10.11648/j.ijovs.20200501.18

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ACS Style

Harsh Kumar; Chirag Mittal; Arushi Puri. Descemet’s Membrane Injury Post YAG Peripheral Iridotomy. Int. J. Ophthalmol. Vis. Sci. 2020, 5(1), 38-40. doi: 10.11648/j.ijovs.20200501.18

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AMA Style

Harsh Kumar, Chirag Mittal, Arushi Puri. Descemet’s Membrane Injury Post YAG Peripheral Iridotomy. Int J Ophthalmol Vis Sci. 2020;5(1):38-40. doi: 10.11648/j.ijovs.20200501.18

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@article{10.11648/j.ijovs.20200501.18,
  author = {Harsh Kumar and Chirag Mittal and Arushi Puri},
  title = {Descemet’s Membrane Injury Post YAG Peripheral Iridotomy},
  journal = {International Journal of Ophthalmology & Visual Science},
  volume = {5},
  number = {1},
  pages = {38-40},
  doi = {10.11648/j.ijovs.20200501.18},
  url = {https://doi.org/10.11648/j.ijovs.20200501.18},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ijovs.20200501.18},
  abstract = {Neodymium: Yittrium - Aluminium-Garnet (Nd YAG) laser iridotomy is one of the most common laser procedures performed in the Asian continent as the proportion of Angle closure glaucoma cases is significant. The Nd YAG iridotomy appears to be a simple outpatient procedure but can result in a number of complications including haemorrhage, cataract formation, dysphotopsia, intraocular pressure elevation and corneal endothelial damage resulting in corneal decompensation at a later date. A forty one year old female patient, a case of Primary Angle Closure Suspect (PACS), who had undergone a Nd YAG laser iridotomy of both the eyes elsewhere presented to us for a second opinion. The anterior segment examination was unremarkable except for the bilateral peripheral Iridotomies. The slit lamp examination revealed three small defects in the temporal cornea at the level of the Descemet’s membrane and posterior stroma overlying the iridotomy in the right eye. A specular microscopy did not reveal any endothelial damage or change in the cell morphology overlying the iridotomy or in other areas. Anterior segment Ocular Coherence Tomography (OCT) demonstrated the exact nature of the injury to the Decemets membrane. To the best of our knowledge, its the first case report in the literature of a Descmet’s membrane injury following a ND-YAG laser iridotomy. It emphasizes the importance of accurate focus on the iris and choosing a quadrant with adequate distance between the iris and the cornea to avoid injury to surrounding structures.},
 year = {2020}
}

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TY  - JOUR
T1  - Descemet’s Membrane Injury Post YAG Peripheral Iridotomy
AU  - Harsh Kumar
AU  - Chirag Mittal
AU  - Arushi Puri
Y1  - 2020/03/06
PY  - 2020
N1  - https://doi.org/10.11648/j.ijovs.20200501.18
DO  - 10.11648/j.ijovs.20200501.18
T2  - International Journal of Ophthalmology & Visual Science
JF  - International Journal of Ophthalmology & Visual Science
JO  - International Journal of Ophthalmology & Visual Science
SP  - 38
EP  - 40
PB  - Science Publishing Group
SN  - 2637-3858
UR  - https://doi.org/10.11648/j.ijovs.20200501.18
AB  - Neodymium: Yittrium - Aluminium-Garnet (Nd YAG) laser iridotomy is one of the most common laser procedures performed in the Asian continent as the proportion of Angle closure glaucoma cases is significant. The Nd YAG iridotomy appears to be a simple outpatient procedure but can result in a number of complications including haemorrhage, cataract formation, dysphotopsia, intraocular pressure elevation and corneal endothelial damage resulting in corneal decompensation at a later date. A forty one year old female patient, a case of Primary Angle Closure Suspect (PACS), who had undergone a Nd YAG laser iridotomy of both the eyes elsewhere presented to us for a second opinion. The anterior segment examination was unremarkable except for the bilateral peripheral Iridotomies. The slit lamp examination revealed three small defects in the temporal cornea at the level of the Descemet’s membrane and posterior stroma overlying the iridotomy in the right eye. A specular microscopy did not reveal any endothelial damage or change in the cell morphology overlying the iridotomy or in other areas. Anterior segment Ocular Coherence Tomography (OCT) demonstrated the exact nature of the injury to the Decemets membrane. To the best of our knowledge, its the first case report in the literature of a Descmet’s membrane injury following a ND-YAG laser iridotomy. It emphasizes the importance of accurate focus on the iris and choosing a quadrant with adequate distance between the iris and the cornea to avoid injury to surrounding structures.
VL  - 5
IS  - 1
ER  -

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Author Information

Harsh Kumar

Centre For Sight Eye Hospital, New Delhi, India
Chirag Mittal

Centre For Sight Eye Hospital, New Delhi, India
Arushi Puri

Centre For Sight Eye Hospital, New Delhi, India

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APA Style

Harsh Kumar, Chirag Mittal, Arushi Puri. (2020). Descemet’s Membrane Injury Post YAG Peripheral Iridotomy. International Journal of Ophthalmology & Visual Science, 5(1), 38-40. https://doi.org/10.11648/j.ijovs.20200501.18

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ACS Style

Harsh Kumar; Chirag Mittal; Arushi Puri. Descemet’s Membrane Injury Post YAG Peripheral Iridotomy. Int. J. Ophthalmol. Vis. Sci. 2020, 5(1), 38-40. doi: 10.11648/j.ijovs.20200501.18

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AMA Style

Harsh Kumar, Chirag Mittal, Arushi Puri. Descemet’s Membrane Injury Post YAG Peripheral Iridotomy. Int J Ophthalmol Vis Sci. 2020;5(1):38-40. doi: 10.11648/j.ijovs.20200501.18

Copy | Download

@article{10.11648/j.ijovs.20200501.18,
  author = {Harsh Kumar and Chirag Mittal and Arushi Puri},
  title = {Descemet’s Membrane Injury Post YAG Peripheral Iridotomy},
  journal = {International Journal of Ophthalmology & Visual Science},
  volume = {5},
  number = {1},
  pages = {38-40},
  doi = {10.11648/j.ijovs.20200501.18},
  url = {https://doi.org/10.11648/j.ijovs.20200501.18},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ijovs.20200501.18},
  abstract = {Neodymium: Yittrium - Aluminium-Garnet (Nd YAG) laser iridotomy is one of the most common laser procedures performed in the Asian continent as the proportion of Angle closure glaucoma cases is significant. The Nd YAG iridotomy appears to be a simple outpatient procedure but can result in a number of complications including haemorrhage, cataract formation, dysphotopsia, intraocular pressure elevation and corneal endothelial damage resulting in corneal decompensation at a later date. A forty one year old female patient, a case of Primary Angle Closure Suspect (PACS), who had undergone a Nd YAG laser iridotomy of both the eyes elsewhere presented to us for a second opinion. The anterior segment examination was unremarkable except for the bilateral peripheral Iridotomies. The slit lamp examination revealed three small defects in the temporal cornea at the level of the Descemet’s membrane and posterior stroma overlying the iridotomy in the right eye. A specular microscopy did not reveal any endothelial damage or change in the cell morphology overlying the iridotomy or in other areas. Anterior segment Ocular Coherence Tomography (OCT) demonstrated the exact nature of the injury to the Decemets membrane. To the best of our knowledge, its the first case report in the literature of a Descmet’s membrane injury following a ND-YAG laser iridotomy. It emphasizes the importance of accurate focus on the iris and choosing a quadrant with adequate distance between the iris and the cornea to avoid injury to surrounding structures.},
 year = {2020}
}

Copy | Download

TY  - JOUR
T1  - Descemet’s Membrane Injury Post YAG Peripheral Iridotomy
AU  - Harsh Kumar
AU  - Chirag Mittal
AU  - Arushi Puri
Y1  - 2020/03/06
PY  - 2020
N1  - https://doi.org/10.11648/j.ijovs.20200501.18
DO  - 10.11648/j.ijovs.20200501.18
T2  - International Journal of Ophthalmology & Visual Science
JF  - International Journal of Ophthalmology & Visual Science
JO  - International Journal of Ophthalmology & Visual Science
SP  - 38
EP  - 40
PB  - Science Publishing Group
SN  - 2637-3858
UR  - https://doi.org/10.11648/j.ijovs.20200501.18
AB  - Neodymium: Yittrium - Aluminium-Garnet (Nd YAG) laser iridotomy is one of the most common laser procedures performed in the Asian continent as the proportion of Angle closure glaucoma cases is significant. The Nd YAG iridotomy appears to be a simple outpatient procedure but can result in a number of complications including haemorrhage, cataract formation, dysphotopsia, intraocular pressure elevation and corneal endothelial damage resulting in corneal decompensation at a later date. A forty one year old female patient, a case of Primary Angle Closure Suspect (PACS), who had undergone a Nd YAG laser iridotomy of both the eyes elsewhere presented to us for a second opinion. The anterior segment examination was unremarkable except for the bilateral peripheral Iridotomies. The slit lamp examination revealed three small defects in the temporal cornea at the level of the Descemet’s membrane and posterior stroma overlying the iridotomy in the right eye. A specular microscopy did not reveal any endothelial damage or change in the cell morphology overlying the iridotomy or in other areas. Anterior segment Ocular Coherence Tomography (OCT) demonstrated the exact nature of the injury to the Decemets membrane. To the best of our knowledge, its the first case report in the literature of a Descmet’s membrane injury following a ND-YAG laser iridotomy. It emphasizes the importance of accurate focus on the iris and choosing a quadrant with adequate distance between the iris and the cornea to avoid injury to surrounding structures.
VL  - 5
IS  - 1
ER  -

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