Contributor: William Charles Caccamise, Sr, MD, Retired Clinical Assistant Professor of Ophthalmology, University of Rochester School of Medicine and Dentistry
*Dr. Caccamise has very generously shared his images of patients taken while operating during the "eye season" in rural India as well as those from his private practice during the 1960's and 1970's. Many of his images are significant for their historical perspective and for techniques and conditions seen in settings in undeveloped areas.
Descemetocele: a corneal ulcer ,e.g. ulcus serpens or keratomalacia, eroded through the stroma leaving only Descemet's membrane. The intraocular pressure - usually elevated by the anterior segment pathology- causes Descemet's membrane to bulge forward,i.e. a descemetocele. Refer to Thiel's Atlas der Augenkrankheiten - the 5th edition has one photograph and the 6th edition has two photographs of descemetocele - due to ulcus serpens and keratomalacia.
Patient in India 1962
A common accompaniment of a descemetocele is its being surrounded by a cloudy, white cicatricial ring. This white ring is evident in this photo and the other descemetocele photos submitted by Dr. Caccamise to this Atlas.
As a result of keratomalacia due to vitamn A deficiency, the cornea is melting away. The usual outcome in such an eye is perforation followed by an overwhelming intraocular infection. Then comes phthisis bulbi or staphyloma formation. Notice the concentric white rings with the descemetocele at their center - a frequent occurrence with a descemetocele.
The dark spot at the center of the leucomatous corneal scar suggests the potntiality for a descemetocele.
Ophthalmic Atlas Images by EyeRounds.org, The University of Iowa are licensed under a Creative Commons Attribution-NonCommercial-NoDerivs 3.0 Unported License.