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      Aspectos qualitativos das rupturas e afinamentos da membrana de Descemet no exame histopatológico Translated title: Qualitative aspects of ruptures and thinnings of Descemet's membrane in histopathological examination

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          Abstract

          Resumo Objetivo: Descrever os diferentes tipos de rupturas e afinamentos da membrana de Descemet encontrados no exame histopatológico, questionando uma possível relação entre eles. Métodos: Estudo observacional, transversal, retrospectivo e descritivo de botões corneanos provenientes de ceratoplastia penetrante, durante o período escolhido de forma aleatória de quatro anos: 2006, 2010, 2014 e 2015. A coloração foi realizada com Hematoxilina-eosina (HE). Após o preparo, os tecidos foram examinados com microscópio óptico pelos autores. Selecionamos apenas os casos de rupturas ou afinamento da membrana de Descemet no exame histopatológico, e classificamos os diferentes tipos desses achados. Resultados: As rupturas encontradas foram classificadas em total ou comum, parcial, fratura e bisel. Os afinamentos foram divididos em generalizado, localizado e extensivo. Conclusão: Apresentamos várias nuances das rupturas e dos afinamentos da membrana de Descemet no exame histopatológico. Os achados sugerem, considerando apenas aspectos mecânicos, uma possível relação entre afinamento e ruptura como causa e efeito.

          Translated abstract

          Abstract Objective: To describe the different types of ruptures and thinning of Descemet's membrane found in the histopathological examination, questioning a possible relationship between them. Methods: Observational, transversal, retrospective and descriptive study of corneal buttons from penetrating keratoplasty during the randomly chosen period of four years: 2006, 2010, 2014 and 2015. The staining was performed with hematoxylin-eosin (HE). After preparation, the authors examined the tissues with an optical microscope. We selected only the cases of rupture or thinning of Descemet's membrane in histopathological examination and classified the different types of these findings. Results: The ruptures found were classified as total or common, partial, fracture and bevel. The thinnings were divided into generalized, localized and extensive. Conclusion: We presented several nuances of Descemet's membrane ruptures and thinning in histopathological examination. Considering only mechanical aspects, the findings suggest a possible relationship between thinning and rupture as cause and effect.

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          A novel histopathologic finding in the Descemet's membrane of a patient with Peters Anomaly: a case-report and literature review

          Background Peters anomaly is a rare developmental abnormality of the anterior segment of the eye and is one of the main causes of congenital corneal opacities. Typically, histopathology of Peters anomaly shows immature or absent Descemet’s membrane and attenuated endothelial cells in the area of the corneal opacity, in addition to thinning or absence of Bowman’s membrane and defects in the posterior stroma. In this report, we present a novel histopathological finding, which has not been previously reported, in the Descemet's membrane of a patient who is clinically diagnosed with Peters anomaly. Case presentation A 7-years old female child with developmentally delayed was born of a normal pregnancy, labor, and delivery. Apparent bilateral corneal opacifications were present at birth. On ophthalmologic examination, the child had a visual acuity of FC/20 cm in the right eye and that of FC/10 cm in the left one. Horizontal nystagmus and congenital cataract were found in both eyes. Slit-lamp examination revealed bilateral central corneal opacities which covered the iris and pupils. High-frequency UBM and AS-OCT both showed a shallow anterior chamber with multiple areas of iridocorneal adhesions and no corneal lenticular touch in each eye. A corneal specialist performed a penetrating keratoplasty with extra-capsular cataract extraction and intraocular lens implantation. Histopathologic procedures were conducted on the host corneal button, including Hematoxylin-Eosin stain and Periodic Acid-Schiff stain. All the sections were examined by light microscopy. Conclusion The “multiple-layer” structure of the Descemet’s membrane described in our case has not been reported before as in association with abnormalities of the cornea tissues in Peters anomaly. Such pathological finding need to be reported to enhance further understanding of the special structure of Descemet's membrane as an abnormality during embryogenesis and neural crest cell differentiations.
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            Forceps and vacuum injuries to the cornea: histopathologic features of twelve cases and review of the literature.

            Histopathologic and ultrastructural features were examined from 11 cases of corneal injury from obstetrical forceps and one case from vacuum extraction. Four major types of histopathologic features were observed. Type I (n = 4) included large tears of Descemet's membrane with a fragment of Descemet's membrane extending into the anterior chamber at one end of the tear and scroll formation at the other end. Type II (n = 6) consisted of scrolls of Descemet's membrane at each margin of the original break. Type III (n = 2) included those with small breaks in Descemet's membrane and healing by fibrosis at and posterior to the original tear. Type IV (n = 1) contained a small break in Descemet's membrane with minimal fibrosis. Transmission electron microscopy revealed Descemet's scrolls and retrocorneal fibrous tissue. Scanning electron microscopy revealed folds in Descemet's membrane and attenuation or absence of endothelium. Spindle- and stellate-shaped cells and pigment granules were present in the area of the tear in most cases. A review of the literature is presented.
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              Complex Descemet's Membrane Tears and Detachment during Phacoemulsification

              Purpose: To report a case of complex Descemet's membrane detachment (DMD) and tears during phacoemulsification cataract surgery. Case Report: A 64-year-old woman underwent phacoemulsification surgery in her right eye and developed tears and partial loss of Descemet's membrane (DM) while the aspiration port was inserted through the main incision. Massive corneal edema obscured the view and the anterior chamber was barely visible the following day. Scheimpflug imaging was used to complement slit lamp examination in the postoperative period. Frequent topical corticosteroid drops were initiated. After 5 days of treatment, multiple tears and detachment of DM were visible and the anterior chamber was filled with air. After 5 weeks, the cornea regained much of its clarity despite large DM tears and focal loss of DM. Conclusion: Despite partial loss of DM, the corneal edema mostly disappeared after 5 weeks of air bubble injection. Scheimpflug imaging was beneficial in the diagnosis and monitoring of DM tears and detachments.
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                Author and article information

                Contributors
                Role: ND
                Role: ND
                Role: ND
                Journal
                rbof
                Revista Brasileira de Oftalmologia
                Rev. bras.oftalmol.
                Sociedade Brasileira de Oftalmologia (Rio de Janeiro, RJ, Brazil )
                0034-7280
                1982-8551
                October 2018
                : 77
                : 5
                : 240-243
                Affiliations
                [1] Fortaleza Ceará orgnameHospital Geral de Fortaleza orgdiv1Banco de Olhos orgdiv2Setor de Patologia Ocular Brazil
                [2] Fortaleza Ceará orgnameHospital Geral de Fortaleza orgdiv1Departamento de Residência Médica de Oftalmologia Brazil
                Article
                S0034-72802018000500240
                10.5935/0034-7280.20180052
                7490ed86-f97e-4b10-b8f8-82e4699372ae

                This work is licensed under a Creative Commons Attribution 4.0 International License.

                History
                : 24 May 2018
                : 29 July 2018
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 23, Pages: 4
                Product

                SciELO Brazil


                Lâmina limitante posterior/patologia,Descemet's membrane/pathology,Ruptures,Ruptura,Cornea,keratoplasty,Ceratoplastia

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