Tissue Plasminogen Activator: Novel Treatment for Hemorrhagic Descemet Detachment After Canaloplasty

Monday, April 20, 2015: 2:15 PM
Room 1A (San Diego Convention Center)
Mohammad Hamid, MD
Paul J. Harasymowycz, MD

To describe a case of hemorrhagic Descemet membrane detachment following canaloplasty and discuss its management using alteplase, a tissue plasminogen activator.

Interventional case report.

A 60-year-old woman with advanced pseudoexfoliation glaucoma developed a severe hemorrhagic descemet detachment after canaloplasty. Initial anterior chamber and pre-descemet washout yielded no improvement. On the 5th post operative day, the patient received a novel pre-descemet treatment using a tissue plasminogen activator with an anterior chamber air bubble. The intracorneal blood cloth quickly dissolved intraoperatively with the descemet membrane almost completely reattached on post operative day 1.

Hemorrhagic descemet detachment is a rare and morbid complication of canaloplasty. The use of pre-descemet tissue plasimogen activator dissolves the intracorneal blood cloth and helps reattach descemet’s membrane, allowing a quick rehabilitation of the patient vision and preserving the integrity of his cornea.