Retrocorneal fibrous membrane after phacoemulsification in an eye with pseudoexfoliative glaucoma

• Published in: Canadian journal of ophthalmology 2024-08, Vol.59 (4), p.241-246
• Main Authors: AlShaker, Sara M., Nguyen, Lananh N., Teichman, Joshua C.
• Format: Article
• Language: English
• Subjects: Aged, 80 and over; Corneal Edema - diagnosis; Corneal Edema - etiology; Corneal Edema - surgery; Descemet Membrane - pathology; Descemet Membrane - surgery; Descemet Stripping Endothelial Keratoplasty - methods; Exfoliation Syndrome - complications; Exfoliation Syndrome - diagnosis; Exfoliation Syndrome - surgery; Female; Glaucoma, Open-Angle - complications; Glaucoma, Open-Angle - diagnosis; Glaucoma, Open-Angle - physiopathology; Glaucoma, Open-Angle - surgery; Humans; Intraocular Pressure - physiology; Phacoemulsification; Postoperative Complications; Tomography, Optical Coherence - methods; Trabeculectomy; Visual Acuity
• ISSN: 0008-4182; 1715-3360; 1715-3360
• DOI: 10.1016/j.jcjo.2023.07.019

To report a case of a retrocorneal fibrous membrane and corneal decompensation following uncomplicated phacoemulsification in an eye with pseudoexfoliative glaucoma. Case report and literature review. A monocular 83-year-old female developed corneal decompensation 1 year after uncomplicated cataract extraction via phacoemulsification. She had a history of pseudoexfoliative glaucoma and had undergone 3 rounds of selective laser trabeculoplasty in the same eye 3 years prior. Given the resulting corneal edema, the patient underwent Descemet's membrane endothelial keratoplasty, at which time a retrocorneal fibrous membrane was identified. Peeling of the membrane was surgically challenging and resulted in an intraocular hemorrhage intraoperatively and a small iridodialysis because the membrane had extended over the angle and iris. Postoperatively, the cornea cleared well, and vision improved significantly. However, vision was ultimately limited by macular pathology. Pathologic examination demonstrated Descemet's membrane with an attached fibrocellular membrane. Immunostaining for smooth muscle actin was positive within the membrane compatible with a retrocorneal membrane. We also present a review of the literature on modern causes of retrocorneal fibrous membranes. Retrocorneal fibrous membranes are encountered most commonly following corneal transplantation and may be surgically challenging to remove. We present the first case of a pathologically proven retrocorneal fibrous membrane following uncomplicated cataract surgery via phacoemulsification and selective laser trabeculoplasty. Présenter un cas clinique d'apparition d'une membrane fibreuse rétrocornéenne et de décompensation cornéenne à la suite d'une phacoémulsification non compliquée dans un œil atteint de glaucome pseudo-exfoliatif. Nous présentons en outre une revue de synthèse de la littérature médicale sur les causes modernes de l'apparition d'une membrane fibreuse rétrocornéenne. Cas clinique et revue de la littérature médicale. Il s'agit d'une femme de 83 ans n'ayant qu'un seul œil et présentant une décompensation cornéenne 1 an après l'extraction non compliquée d'une cataracte par phacoémulsification. La patiente, porteuse d'antécédents de glaucome pseudo-exfoliatif, avait subi 3 ans plus tôt une trabéculoplastie sélective au laser à 3 reprises dans le même œil. Compte tenu de l’œdème cornéen qui s'en est suivi, on a procédé à une kératoplastie endothéliale de la membrane de Descemet, laquelle a