The Descemet Membrane in Primary Congenital Glaucoma.

PURPOSE: To evaluate Descemet membrane (DM) morphology in eyes with primary congenital glaucoma (PCG) in vivo using high-definition anterior segment optical coherence tomography (ASOCT) and on histopathology.

METHODS

Corneal scans of patients with PCG (22 eyes of 15 patients) were evaluated for DM morphology and anterior chamber angle using ASOCT. The DM thickness in PCG eyes was compared with fellow eyes (8 eyes) of unilateral patients with PCG and healthy controls (12 eyes) on ASOCT. The DM morphology was also compared on the histopathology of corneal tissues (9) obtained from PCG eyes after keratoplasty and enucleated eyes of retinoblastoma (6 controls) on light microscopy with immunostaining for collagen IV.

RESULTS

On ASOCT, all affected eyes showed the presence of either a thickened DM complex or a hyper-reflective double layer representing the thickened DM and pre-Descemet layer (PDL), unlike a single membrane in the controls and fellow eyes. On ASOCT, among patients with PCG, the DM showed significant thickening (32.0 ± 11.2 μm) versus fellow eyes (14.4 ± 3.3 μm) and controls (11.5 ± 1 μm) (P < 0.001; analysis of variance). The thickened DM complex continued peripherally into the trabecular meshwork as an abnormal membrane in 16/22 affected eyes. On histopathology, thickening of DM was also more among PCG eyes (median: 67.9 μm range: 27.2-214.9) versus controls (median: 27.7 μm, range: 22.1-36.1; P = 0.005) as also of PDL (median: 14 μm, range: 5.9-30.5) of PCG versus (median 3.5, range: 1.3-6.7 μm) in controls; P = 0.014.

CONCLUSIONS

Thickening of DM and PDL occurs in eyes with PCG and is seen to have a peripheral extension upto the angle recess.