Hemorrhagic Descemet’s Membrane Detachment After Gonioscopy-Assisted Transluminal Trabeculotomy

Purpose: To report a rare case of hemorrhagic Descemet’s membrane detachment (DMD) after gonioscopy-assisted transluminal trabeculotomy (GATT) and to discuss its management. Methods: A 71-year-old male patient with advanced pseudoexfoliation glaucoma and dense cataract was planned to perform combined GATT and cataract extraction. DMD was noticed after blood reflux from Schlemm canal during GATT. Circumferential ab-interno trabeculotomy was completed and DMD was reattached with air tamponade. Cataract extraction was postponed to prevent the progression of DMD. Results: Hemorrhagic DMD was monitored during a 3-month follow-up. Spontaneous resorption was not observed. A side port incision was made at the site of hemorrhagic DMD during cataract extraction. The space upon DM was washed out with a balanced salt solution to allow drainage of the hemorrhage and an air bubble was left in the anterior chamber. On the first postoperative day after cataract extraction, DM was observed to be attached and the hemorrhage had disappeared completely. Conclusions: Hemorrhagic DMD is an unusual complication after GATT and it may be challenging to manage. Surgeons who perform GATT should be aware of this rare corneal complication.