-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.
SWIPE TO SEE A FEW CLASSIFICATIONS OF DMD.
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Image from Rajan Eye Care Hospital
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