Intracorneal inclusion of high-molecular-weight sodium hyaluronate following detachment of Descemet's membrane during viscocanalostomy

Abstract

Purpose: Viscocanalostomy in accordance with Stegmann's technique is a new surgical option in the treatment of glaucoma. There are few reports available describing the specific complications of viscocanalostomy. We report a case of intracorneal inclusion of high-molecular-weight sodium hyaluronate following viscocanalostomy.

Case report: A 66-year-old man with uncontrolled primary open angle glaucoma of his right eye and a history of argon laser trabeculoplasty underwent viscocanalostomy in accordance with Stegmann's technique. During the filling of Schlemm's canal, a limited lysis of Descemet's membrane advanced centrally in the clear cornea adjacent to the site of canalostomy forming an intracorneal bubble of high-molecular-weight sodium hyaluronate. Postsurgical slit-lamp biomicroscopy showed an intracorneal clear bubble within the corneal periphery without evidence of adjacent corneal edema and with no contact between the corneal endothelium and the iris. Follow-up examinations determined that the appearance of the corneal inclusion, essentially, was unchanged, with only a slight tendency of resorption. No signs of corneal scarring or endothelial decompensation could be noted.

Conclusion: To date, we could not determine a significant corneal damage in conjunction with the described complication. However, it is difficult to predict the long-term clinical course of our patient. Corneal decompensation as a result of possible endothelial toxicity of high-molecular weight sodium hyaluronate as well as spontaneous absorption seem possible.