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| PHOTO ESSAY |
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| Year : 2022 | Volume
: 2
| Issue : 2 | Page : 563-564 |
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Iceberg phenomenon of striate keratopathy
A Arut Priya, Bala Saraswathy, Kalpana Narendran
Department of Cataract and IOL, Aravind Eye Hospital, Coimbatore, Tamil Nadu, India
| Date of Submission | 17-Jun-2021 |
| Date of Acceptance | 24-Nov-2021 |
| Date of Web Publication | 13-Apr-2022 |
Correspondence Address:
A Arut Priya
Department of cataract and IOL, Aravind eye hospital, Coimbatore, Tamil Nadu
India
 Source of Support: None, Conflict of Interest: None
DOI: 10.4103/ijo.IJO_1605_21
Keywords: Anterior segment OCT, Descemet's membrane, slit lamp examination, striate keratopathy
How to cite this article:
Priya A A, Saraswathy B, Narendran K. Iceberg phenomenon of striate keratopathy. Indian J Ophthalmol Case Rep 2022;2:563-4 |
A 60-year-old female patient underwent right eye manual small-incision cataract surgery. In the immediate postoperative period, vision in RE was 5/60 with no further improvement. Diffuse examination showed dense central striate keratopathy. Direct focal slit-lamp examination showed stromal edema and elastic Descemet's membrane curled and detached from the underlying stroma [Figure 1]. AS-OCT was taken which showed Descemet's membrane detachment involving central cornea [Figure 2]. Pneumatic descemetopexy was planned. DM was reapposed with C3F8. One week after surgery, vision improved to 6/12 with PH 6/9, and central dense SK resolved. This emphasizes the importance of focal slit-lamp examination and AS-OCT in suspected cases of diffuse SK to rule out Descemet's membrane detachment at the earliest and prevent its complications. | Figure 1: (a) slit lamp diffuse examination showing central dense striate keratopathy (b) focal examination showing stromal edema and Descemetæs membrane detachment
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 | Figure 2: AS-OCT showing descemet's membrane detachment involving central cornea
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| Discussion | |  |
DMD must be suspected when unexpected corneal edema is noted on the day after surgery. In the presence of significant edema, it is not unusual for an underlying DM detachment to be missed unless specifically looked for.
Management protocols based on AS-OCT criteria have been proposed, including HELP algorithms by Kumar et al., Jacob et al., Sharma et al., which help in deciding the management.[1],[2],[3] If diagnosed and managed early, the success rates are 70%–75%, especially in uncomplicated DMD.[4] If not, it may lead to complete DMD, folding, and scaring of DM, or sometimes, DM may fail to reattach partially or completely.[5]
Never underestimate striate keratopathy as a usual postoperative complication. Dense SK gives a clue to the underlying DMD, and that should be diagnosed as early as possible and should be treated to prevent further deterioration of the vision. In our case, slit-lamp examination alone showed well-delineated DMD through dense SK involving the pupillary area which is documented rarely.
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
| References | | |
| 1. | Kumar DA, Agarwal A, Sivanganam S, Chandrasekar R. Height-, extent-, length-, and pupil-based (HELP) algorithm to manage post-phacoemulsification Descemet membrane detachment. J Cataract Refract Surg 2015;41:1945–53.  |
| 2. | Sharma N, Singhal D, Nair SP, Sahay P, Sreeshankar SS, Maharana PK. Corneal edema after phacoemulsification. Indian J Ophthalmol 2017;65:1381-9. [ PUBMED] [Full text] |
| 3. | Jacob S, Agarwal A, Chaudhry P, Narasimhan S, Chaudhry VN. A new clinico-tomographic classification and management algorithm for Descemet's membrane detachment. Cont Lens Anterior Eye 2015;38:327–33. |
| 4. | Odayappan A, Shivananda N, Ramakrishnan S, Krishnan T, Nachiappan S, Krishnamurthy S. A retrospective study on the incidence of post-cataract surgery Descemet's membrane detachment and outcome of air descemetopexy. Br J Ophthalmol. 2018;102:182-6. |
| 5. | Singhal D, Sahay P, Goel S, Asif MI, Maharana PK, Sharma N. Descemet membrane detachment. Surv Ophthalmol 2020;65:279-93. |
[Figure 1], [Figure 2]
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