Intracorneal inclusion of high-molecular-weight sodium hyaluronate following detachment of Descemet's membrane during viscocanalostomy

Purpose. Viscocanalostomy in accordance with Stegmann's technique is a new surgical option in the treatment of glaucoma. There are few reports availab le describing the specific complications of viscocanalostomy. We report a c ase of intracorneal inclusion of high-molecular-weight sodium hyaluronate f ollowing viscocanalostomy. Case Report, A 66-year-old man with uncontrolled primary open angle glaucoma of his right eye and a history of argon laser trabeculoplasty underwent viscocanalostomy in accordance with Stegmann's te chnique. During the filling of Schlemm's canal, a limited lysis of Descemet 's membrane advanced centrally in the clear cornea adjacent to the site of canalostomy forming an intracorneal bubble of high-molecular-weight sodium hyaluronate. Postsurgical slit-lamp biomicroscopy showed an intracorneal cl ear bubble within the corneal periphery without evidence of adjacent cornea l edema and with no contact between the corneal endothelium and the iris. F ollow-up examinations determined that the appearance of the corneal inclusi on, essentially, was unchanged, with only a slight tendency of resorption. No signs of corneal scarring or endothelial decompensation could be noted. Conclusion. To date, we could not determine a significant corneal damage in conjunction with the described complication. However, it is difficult to p redict the long-term clinical course of our patient. Corneal decompensation as a result of possible endothelial toxicity of high-molecular weight sodi um hyaluronate as well as spontaneous absorption seem possible.