Descemet’s membrane detachments preliminary results

Vet Ophthalmol. 2020 Jul;23(4):611-623. doi: 10.1111/vop.12793. Epub 2020 Jun 11.
Descemet’s membrane detachments, ruptures, and separations in ten adult horses: Clinical signs, diagnostics, treatment options, and preliminary results
Roxanne M Rodriguez Galarza 1, Richard J McMullen Jr 2
Affiliations expand
PMID: 32529665 DOI: 10.1111/vop.12793
Abstract
Objective: To describe the clinical presentation, diagnostic imaging results, and treatment outcomes of a series of presumed spontaneous Descemet’s membrane detachments (DMD), ruptures, or separations (DMRS) in the adult horse.

Animals studied: Ten adult horses of various breeds with DMD or DMRS.

Procedures: Descemet’s membrane detachments/DMRS were diagnosed via slit lamp biomicroscopy, ultrasound biomicroscopy (UBM), and/or optical coherence tomography (OCT). Penetrating keratoplasty (PK) with heterologous corneal donor tissue (n = 1), superficial lamellar keratectomy, and Gundersen inlay flaps alone (GF, n = 1) or with subsequent intracamerally assisted corneal tissue welding (CTW, n = 2), or CTW alone (n = 5) were performed in 9/10 horses. One horse underwent spontaneous resolution (n = 1).

Results: Ten horses were diagnosed with either unilateral DMD (n = 4) or DMRS (n = 6). Seven of ten eyes remained visual during the follow-up period (8.16 ± 6.57 months). Graft transparency was good for the eye treated with PK. The horse that underwent GF alone was functionally blind due to persistent corneal edema. The clinical signs resolved in 3/5 horses that underwent CTW alone, but 2/5 eyes were enucleated due to corneal perforation. Both eyes treated with combined GF/CTW had significant corneal clearing with one having evidence of reattachment on UBM and OCT.

Conclusions: Descemet’s membrane detachments separations presents differently than typical DMD and advanced corneal imaging modalities may aid in their diagnosis. Corneal tissue welding using infraCG as the photosensitive agent, or in combination with Gundersen inlay flaps, represents a feasible treatment option for management of equine DMD/DMRS as described in the present case series.

Keywords: Descemet’s membrane detachment; EmunDo®; Gundersen inlay flaps; corneal tissue welding; equine ophthalmology; infracyanine green; optical coherence tomography.