PURPOSE: Viscocanalostomy is a new, non-penetrating
procedure in the treatment of glaucoma. There are few reports available
describing the specific complications of viscocanalostomy. We report a case of
serous descemet’s detachment by high-molecular-weight sodium hyaluronate after
viscocanalostomy.
CASE REPORT: A 74-year-old man with pseudoexfoliative
glaucoma of his right eye underwent viscocanalostomy in accordance with
Stegmann's technique. No complication was seen in perop or early surgical
period. Postsurgical slit-lamp biomicroscopy after one month showed a
descemet’s detachment at 1/3 upper nasal quadrant of cornea without corneal
edema. Optical coherens tomography (OCT) showed detached descement membrane and
no contact between the corneal endothelium and the iris. Visual acuity was
unchanged in early postoperative period. During follow-up examinations, mild
corneal oedema appeared with gradually loss of visual acuity. High viscosity
sodium hyalurinate gently aspirated from the detachment area with
viscocanalostomy cannula and 0.3 ml of SF6 gases injected into anterior chamber
to repair the descemet’s detachment. There was no sign of corneal scarring or
endothelial decompensation after the procedure and visual acuity increased in
time. OCT scans showed reattached descemet’s membrane.
CONCLUSION: We could not explain the real mechanism how viscoelastic substance detached the descemet’s membrane after one month following viscocanalostomy. OCT might be useful both for the diagnosis and during the follow-up. Corneal oedema might be a result of possible endothelial toxicity of high-molecular weight sodium hyaluronate. We recommend gently aspiration of viscoelastic material from the detached area when a significant corneal oedema appears.