Tractional Descemet’s membrane detachment after ocular alkali burns: case reports and review of literature

A 44-year-old male was referred to our hospital 26 days after an accidental chemical injury in his left eye with 50% sodium hydroxide solution. The patient irrigated his left eye with tap water immediately after the injury and was subsequently treated at a local clinic. At the time of presentation to our hospital, his visual acuity was hand movements in the left eye and 20/20 in the right eye. Slit-lamp examination revealed an inferior corneal epithelial defect involving 2 clock hours along with diffuse corneal epithelial and stromal edema (Fig. 1a). The patient was treated with 0.3% ofloxacin four times a day, pranoprofen 1% four times a day, 0.1% prednisolone acetate eye drops four times a day, 1% atropine sulfate eye gel twice daily and oral 2000 mg vitamin C per day. The patient was advised to follow-up in our clinic on a weekly basis. The epithelial defect resolved at one week follow up, when the best-corrected visual acuity (BCVA) improved to 20/400. Six weeks after the initial injury, DMD was noted in the inferonasal quadrant on slit-lamp examination (Fig. 1b) and the BCVA was 20/200. AS-OCT scan confirmed a localized DMD in the inferior quadrant. The detached Descemet membrane was thick and adherent to the underlying iris tissue. The iris was pulled anteriorly (Fig. 1c-f). Confocal scanning microscopy failed to detect the corneal endothelium. On the following day, 0.1 ml of 12% perfluoropropane (C₃F₈) gas was injected into the anterior chamber. However, the detached Descemet’s membrane persisted postoperatively (Fig. 1g and h). The central cornea clarity improved gradually and the BCVA of the left eye recovered to 20/100 and 20/50 at two and four months after the initial injury.

A 28-year-old male presented to our hospital after ocular chemical injury with 50% sodium hydroxide. The patient irrigated his eyes with tap water immediately after the injury and presented an hour later to our hospital. At the time of presentation, the BCVA was 20/40 in the right eye and 20/200 in the left eye. There was extensive corneal edema along with limbal ischaemia (Fig. 2a). Treatment was commenced in the form of topical levofloxacin 0.5% four times a day, topical pranoprofen 1% four times a day, topical atropine 1% gel nocte and oral vitamin C 2000 mg per day. Five weeks later, slit lamp examination revealed a DMD, which had not been present during the initial examination. AS-OCT showed a localized DMD in the inferior quadrant. Similar to the first case, the detached Descemet membrane was thick, adherent to the underlying iris tissue and pulled the iris anteriorly (Fig. 2c-f). Topical prednisolone acetate 1% eye drops and sodium chloride 5% eye drops were administered every 2 h; however, the DMD persisted at the end of one week and one month (Fig. 2g and h). There was severe corneal neovascularization (Fig. 2b) and the BCVA of left eye dropped to hand movements at one-year follow-up visit. He received penetrating keratoplasty at another institute and the BCVA improved to 20/200 postoperatively.