Descemet’s membrane (DM) detachment is not always a lone event and may be accompanied by another structure (the so-called Dua’s layer) that also separates at the same time, a study in the American Journal of Ophthalmology suggests.

An international team of researchers analyzed the clinical, histopathological and OCT features of 41 cases diagnosed with DM detachment. Three observers independently evaluated the OCT images for number of detached layers (one or two), reflectivity, configuration (straight line or wavy), distance from posterior stroma and presence or absence of a tear with any scrolling of the torn edges.

The study identified three types of DM detachment:

  • Type 1, where the pre-Descemet’s layer and DM were detached together
  • Type 2, where only the DM was detached
  • Mixed, where the pre-Descemet’s layer and DM were detached but also separated from each other.

The investigators noted the DM attachments were also found to be rhegmatogenous or non-rhegmatogenous, depending on the presence or absence of a tear in DM or both layers.

Of the five cases with histology specimens, all of them involved a pre-Descemet’s layer and three showed cell infiltration.

The finding that the pre-Descemet’s layer is involved in DM detachment significantly changes the understanding of the condition and could have management implications, the researchers suggest. A prospective study in relation to etiology and types of DM detachment are warranted, they added.

Dau HS, Sinha R, D’Souza S, et al. Descemet’s membrane detachment: A novel concept in diagnosis and classification. Am J Ophthalmol. June 20, 2020. [Epub ahead of print].