Download Descemetocele Ulcers - Memphis Veterinary Specialists

Advanced Animal Eye Care
Dr. William Miller DVM, MS Diplomate ACVO
888-323-5203/901-323-5203
www.advancedanimaleyecare.com
Descemetocele Ulcers
What is a Descemetocele ulcer?
The cornea is made up of basically four layers. The surface layer is epithelium. Below the
epithelium is the stroma which comprises more than 90% of the corneal thickness.
Immediately beyond the stroma is the Descemet’s membrane and just before entering
the eye’s anterior chamber is the endothelium. Any break that penetrates the epithelium
is an ulcer. An ulcer is considered deep if it extends into the middle layers of the stroma.
A descemetocele is a deep ulcer that penetrates to the Descemet’s membrane. A
superficial ulcer may progress for a number of reasons such as decreased tear
production, incomplete eyelid closure, foreign bodies, inappropriate treatment, and most
commonly serious bacterial infection. There are several bacteria species that produce
enzymes that “melt” tissue. The bacteria enzymes destroy the tissue to produce a more
suitable environment in which to replicate. The most common bacteria responsible for
this type of tissue destruction are Pseudomonas species and beta-hemolytic
Streptococcus species. Once an ulcer has progressed to Descemet’s membrane, there is
only about the thickness of a single red blood cell from being a hole completely through
the eye.
How is a Descemetocele ulcer diagnosed?
A slit lamp examination is best to determine the depth of an ulcer into the cornea.
Commonly fluorescein stain is used to diagnose an ulcer. When an ulcer progresses to
Descemet’s membrane, the ulcer will often not demonstrate a positive test because the
membrane will not retain stain.
How are Descemetocele ulcers treated?
The best method of treating a descemetocele ulcer is surgically. We will generally
perform a conjunctival flap to repair the defect. Ulcers need stability, fibroblasts,
nutrition, and oxygen to heal. A conjunctival flap provides the factors required for
efficient healing. A pedicle-based conjunctival flap is the technique most often chosen.
Following surgery, it will appear that there will be a reddened finger of tissue extending
across the cornea and attaching itself to the area of the ulcer. Other surgical procedures
such as corneal transplants may also be considered. Medical treatment will also be used
following surgery. Atropine will be used to reduce pain and make the eye more
comfortable and an antibiotic will prescribed to combat the bacterial infection. A
bacterial culture may be obtained prior to surgery to determine what bacteria are present
and which appropriate antibiotic is needed to control infection. Most cases are
reevaluated 2 weeks after surgery and again in 6-8 weeks later. At the last reevaluation,
the conjunctival flap may be released or cut loose from the cornea. Ultimately, there will
be a small scar at the sight of the ulcer. Medical therapy is generally not effective in most
descemetocele ulcers but ma be prescribed in isolated case.
Will my pet be able to see after the ulcer is treated?
Yes. Most of the time vision can be saved. Even the most severe ulcers can often be
treated successfully. They key to success requires correcting the underlying causes,
arresting the bacterial infection and aggressive and appropriate treatment after surgery.