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Descemet's Membrane Detachment by Sodium Hyaluronate

Descemet's Membrane Detachment by Sodium Hyaluronate Abstract • The inadvertent injection of sodium hyaluronate (Healon) just anterior to Descemet's membrane during an extracapsular cataract extraction resulted in a corneal opacity. No extraordinary measures were taken to remove this substance. The opacity resolved over five months, with a final visual acuity of 20/25 and a reduction in specular microscopic cell density from 2,600 to 2,100/sq mm. Sodium hyaluronate was injected in an analogous manner into eight rabbit corneas. The eyes were enucleated, and histologic sections were examined 1, 5, 9, and 14 days later. Sodium hyaluronate injected just anterior to Descemet's membrane was found to incite an acute mild granulocytic response, which is followed by a macrophage invasion and ingestion of this substance. We recommend a conservative approach when the central portion of Descemet's membrane is detached by sodium hyaluronate during anterior segment surgery. References 1. Balazs EA, Miller D, Stegmann R: Viscosurgery and the use of sodium hyaluronate in intraocular lens implantation. Presented as a film at the International Congress and First Film Festival in Intraocular Lens Implantation, Cannes, France, May 1979. 2. Miller D, Stegmann R: Use of sodium hyaluronate in anterior segment surgery . J Am Intraocul Implant Soc 1980;6:13-15.Crossref 3. Pape LG, Balazs EA: The use of sodium hyaluronate in human anterior segment surgery . Ophthalmology 1980;87:699-705.Crossref 4. Hoopes PC: Sodium hyaluronate in anterior segment surgery: A review and new use in extracapsular surgery . J Am Intraocul Implant Soc 1982;8:148-154.Crossref 5. Stegmann R, Miller D: Protective function of sodium hyaluronate in corneal transplantation . J Ocular Ther Surg 1981;1:28-31. 6. Miller D, Stegmann R: Use of sodium hyaluronate in auto-corneal transplantation in rabbits . Ophthalmic Surg 1980;11:19-21. 7. Polack FM, DeMong T, Santaella H: Sodium hyaluronate in keratoplasty and IOL implantation . Ophthalmology 1981;88:425-431.Crossref 8. Hirst LW, DeJuan E: Sodium hyaluronate and tissue adhesive in treating corneal perforations . Ophthalmology 1982;89:1250-1253.Crossref 9. Maguen E, Nesburn AB, Macy JI: Combined use of sodium hyaluronate and tissue adhesive in penetrating keratoplasty of corneal perforations . Ophthalmic Surg 1984;15:55-57. 10. Percival SPB: Complications from the use of sodium hyaluronate in anterior segment surgery . Br J Ophthalmol 1982;66:714-716.Crossref 11. MacRae SM, Edelhauser HF, Hyndiuk RA, et al: The effects of sodium hyaluronate, chondroitin sulfate, and methylcellulose on the corneal endothelium and intraocular pressure . Am J Ophthalmol 1983;95:332-341. 12. Berkowitz PJ: Surgical wound leaks associated with sodium hyaluronate . Am J Ophthalmol 1983;95:714-715. 13. Graether JM: Detachments of Descemet's membrane by the injection of sodium hyaluronate . J Ocular Ther Surg 1984;3:178-181. 14. Metzler DE: Biochemistry: The Chemical Reactions of Living Cells . New York, Academic Press Inc, 1977, pp 85-86. 15. Denlinger JL, Balazs EA: Replacement of liquid vitreous with sodium hyaluronate in monkeys: I. Short term evaluation . Exp Eye Res 1980; 31:81-99.Crossref 16. Denlinger JL, El-Mofty AAM, Balazs EA: Replacement of the liquid vitreous with sodium hyaluronate in monkeys: II. Long term evaluation . Exp Eye Res 1980;31:101-117.Crossref 17. Richter AW: Non-immunogenicity of purified hyaluronic acid preparations tested by passive cutaneous anaphylaxis . Int Arch Allergy Appl Immunol 1974;47:211-217.Crossref 18. Richter AW, Ryde EM, Zetterstrom ED: Non-immunogenicity of a purified sodium hyaluronate preparation in man . Int Arch Allergy Appl Immunol 1979;59:45-48.Crossref 19. Hakansson L, Hallgren R, Venge P: Regulation of granulocyte function by hyaluronic acid . J Clin Invest 1980;66:299-305.Crossref 20. Dahlgren C, Bjorksten B: Effect of hyaluronic acid on polymorphonuclear leukocyte cell surface properties . Scand J Haematol 1982; 28:376-380.Crossref 21. Hayasaka S, Sears ML: Distribution of acid phosphatase, B-glucuronidase, and lysosomal hyaluronidase in the anterior segment of the rabbit eye . Invest Ophthalmol Vis Sci 1978;17:982-987. 22. Hayasaka S, Hara S, Shiono T, et al: Presence of lysosomal hyaluronidase in human corneoscleral tissue . Graefes Arch Clin Exp Ophthalmol 1980;213:235-238.Crossref 23. Praus R, Brettschneider I: Glycosaminoglycans in the developing chicken cornea . Ophthalmol Res 1971;2:367-373.Crossref 24. Toole BP, Trelstad RL: Hyaluronate production and removal during corneal development in the chick . Dev Biol 1971;26:28-35.Crossref 25. Praus R, Brettschneider I: Glycosaminoglycans in embryonic and post-natal human corneas . Ophthalmol Res 1975;7:452-458.Crossref 26. Vastine DW, Weinberg RS, Sugar J, et al: Stripping of Descemet's membrane associated with intraocular lens implantation . Arch Ophthalmol 1983;101:1042-1045.Crossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Ophthalmology American Medical Association

Descemet's Membrane Detachment by Sodium Hyaluronate

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References (29)

Publisher
American Medical Association
Copyright
Copyright © 1985 American Medical Association. All Rights Reserved.
ISSN
0003-9950
eISSN
1538-3687
DOI
10.1001/archopht.1985.01050060065027
Publisher site
See Article on Publisher Site

Abstract

Abstract • The inadvertent injection of sodium hyaluronate (Healon) just anterior to Descemet's membrane during an extracapsular cataract extraction resulted in a corneal opacity. No extraordinary measures were taken to remove this substance. The opacity resolved over five months, with a final visual acuity of 20/25 and a reduction in specular microscopic cell density from 2,600 to 2,100/sq mm. Sodium hyaluronate was injected in an analogous manner into eight rabbit corneas. The eyes were enucleated, and histologic sections were examined 1, 5, 9, and 14 days later. Sodium hyaluronate injected just anterior to Descemet's membrane was found to incite an acute mild granulocytic response, which is followed by a macrophage invasion and ingestion of this substance. We recommend a conservative approach when the central portion of Descemet's membrane is detached by sodium hyaluronate during anterior segment surgery. References 1. Balazs EA, Miller D, Stegmann R: Viscosurgery and the use of sodium hyaluronate in intraocular lens implantation. Presented as a film at the International Congress and First Film Festival in Intraocular Lens Implantation, Cannes, France, May 1979. 2. Miller D, Stegmann R: Use of sodium hyaluronate in anterior segment surgery . J Am Intraocul Implant Soc 1980;6:13-15.Crossref 3. Pape LG, Balazs EA: The use of sodium hyaluronate in human anterior segment surgery . Ophthalmology 1980;87:699-705.Crossref 4. Hoopes PC: Sodium hyaluronate in anterior segment surgery: A review and new use in extracapsular surgery . J Am Intraocul Implant Soc 1982;8:148-154.Crossref 5. Stegmann R, Miller D: Protective function of sodium hyaluronate in corneal transplantation . J Ocular Ther Surg 1981;1:28-31. 6. Miller D, Stegmann R: Use of sodium hyaluronate in auto-corneal transplantation in rabbits . Ophthalmic Surg 1980;11:19-21. 7. Polack FM, DeMong T, Santaella H: Sodium hyaluronate in keratoplasty and IOL implantation . Ophthalmology 1981;88:425-431.Crossref 8. Hirst LW, DeJuan E: Sodium hyaluronate and tissue adhesive in treating corneal perforations . Ophthalmology 1982;89:1250-1253.Crossref 9. Maguen E, Nesburn AB, Macy JI: Combined use of sodium hyaluronate and tissue adhesive in penetrating keratoplasty of corneal perforations . Ophthalmic Surg 1984;15:55-57. 10. Percival SPB: Complications from the use of sodium hyaluronate in anterior segment surgery . Br J Ophthalmol 1982;66:714-716.Crossref 11. MacRae SM, Edelhauser HF, Hyndiuk RA, et al: The effects of sodium hyaluronate, chondroitin sulfate, and methylcellulose on the corneal endothelium and intraocular pressure . Am J Ophthalmol 1983;95:332-341. 12. Berkowitz PJ: Surgical wound leaks associated with sodium hyaluronate . Am J Ophthalmol 1983;95:714-715. 13. Graether JM: Detachments of Descemet's membrane by the injection of sodium hyaluronate . J Ocular Ther Surg 1984;3:178-181. 14. Metzler DE: Biochemistry: The Chemical Reactions of Living Cells . New York, Academic Press Inc, 1977, pp 85-86. 15. Denlinger JL, Balazs EA: Replacement of liquid vitreous with sodium hyaluronate in monkeys: I. Short term evaluation . Exp Eye Res 1980; 31:81-99.Crossref 16. Denlinger JL, El-Mofty AAM, Balazs EA: Replacement of the liquid vitreous with sodium hyaluronate in monkeys: II. Long term evaluation . Exp Eye Res 1980;31:101-117.Crossref 17. Richter AW: Non-immunogenicity of purified hyaluronic acid preparations tested by passive cutaneous anaphylaxis . Int Arch Allergy Appl Immunol 1974;47:211-217.Crossref 18. Richter AW, Ryde EM, Zetterstrom ED: Non-immunogenicity of a purified sodium hyaluronate preparation in man . Int Arch Allergy Appl Immunol 1979;59:45-48.Crossref 19. Hakansson L, Hallgren R, Venge P: Regulation of granulocyte function by hyaluronic acid . J Clin Invest 1980;66:299-305.Crossref 20. Dahlgren C, Bjorksten B: Effect of hyaluronic acid on polymorphonuclear leukocyte cell surface properties . Scand J Haematol 1982; 28:376-380.Crossref 21. Hayasaka S, Sears ML: Distribution of acid phosphatase, B-glucuronidase, and lysosomal hyaluronidase in the anterior segment of the rabbit eye . Invest Ophthalmol Vis Sci 1978;17:982-987. 22. Hayasaka S, Hara S, Shiono T, et al: Presence of lysosomal hyaluronidase in human corneoscleral tissue . Graefes Arch Clin Exp Ophthalmol 1980;213:235-238.Crossref 23. Praus R, Brettschneider I: Glycosaminoglycans in the developing chicken cornea . Ophthalmol Res 1971;2:367-373.Crossref 24. Toole BP, Trelstad RL: Hyaluronate production and removal during corneal development in the chick . Dev Biol 1971;26:28-35.Crossref 25. Praus R, Brettschneider I: Glycosaminoglycans in embryonic and post-natal human corneas . Ophthalmol Res 1975;7:452-458.Crossref 26. Vastine DW, Weinberg RS, Sugar J, et al: Stripping of Descemet's membrane associated with intraocular lens implantation . Arch Ophthalmol 1983;101:1042-1045.Crossref

Journal

Archives of OphthalmologyAmerican Medical Association

Published: Jun 1, 1985

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