Descemet Membrane Detachment - Grading
After the lens vesicle separates from the surface epithelium, a wave of mesenchyme forms the primary corneal stroma.
A second wave then forms the endothelium, which secretes the DM.
The DM, hence, has a potential plane of separation from the corneal stroma, which we use to our benefit in DMEK surgery and which works against us in an inadvertent DM detachment.
ASSESSING THE 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 DMD to be missed unless specifically looked for.
If suspected, dilating the pupil may help, as some of the features of a DMD may be better seen on retro illumination against the red fundal glow seen in a dilated pupil.
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Image from Rajan Eye Care Hospital
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