Permanent decreased vision caused by a descemetic bleb after deep sclerectomy in an emmetropic patient

Resumen

ABSTRACT: A 63-year-old pseudophakic woman with uncorrected visual acuity (UCVA) of 20/20 underwent uncomplicated deep sclerectomy for uncontrolled open-angle glaucoma in her right eye. Eight weeks after glaucoma surgery, the patient presented decreased visual acuity due to a descemetic bleb extending over the visual axis with resultant corneal edema. Initially conservative medical treatment was used, but the corneal edema progressed. Transcorneal fixating matters sutures and intracameral air injection were also unsuccessful. After YAG-laser puncture of the intact Descemet´s membrane, and an intracameral injection of isoexpansile 14% perfluoropropane (C3F8), the Descemet´s membrane rapididly reattached and the corneal edema cleared. One year after descematopexy with C3F8, folds at the level of Descemet´s membrane were present producing loss of corrected-distance visual acuity (CDVA) to 20/30. Perfluoropropane should be considered for complicated cases of descemetic detachment after deep sclerectomy, but permanent loss of CDVA may result if the detachment stands for a long period of time