Bridging the Gap: A Case of Unique Anterior Segment Optical Coherence Tomography Presentation of Retrocorneal Membrane and Fibrous Bridging After Birth-Related Descemet's Membrane Detachment

TL;DR

A case report describes a rare corneal condition caused by birth trauma, diagnosed using advanced imaging and managed conservatively.

Contribution

First report of fibrous bridging in birth-related Descemet's membrane detachment confirmed by AS-OCT.

Findings

AS-OCT confirmed chronic DMD with fibrous bridging and retrocorneal membrane in a birth trauma case.

Conservative management was effective for asymptomatic DMD without visual axis involvement.

Birth trauma markers and posterior corneal striae should prompt DMD evaluation.

Abstract

Descemet’s membrane detachment (DMD) is an uncommon corneal pathology that typically occurs following intraocular surgeries or direct ocular trauma. Congenital or birth trauma-related DMD is rare and often remains undiagnosed in asymptomatic individuals. Longstanding cases may develop fibrous bridging or retrocorneal membrane formation, making diagnosis challenging without advanced imaging.

We report the case of a 32-year-old asymptomatic male who presented for a routine ophthalmic evaluation. Slit-lamp examination of the right eye revealed a localized inferotemporal corneal opacity with subtle posterior corneal striae. The patient’s history was significant for a forceps-assisted birth complicated by right auricular deformity. Anterior segment optical coherence tomography (AS-OCT) demonstrated a planar DMD with fibrous bridging and retrocorneal membrane formation, sparing the visual axis. Best corrected visual acuity was 6/9 partial bilaterally, and intraocular pressures were normal. In the absence of symptoms or visual axis involvement, conservative management with regular follow-up was advised. At six months, the patient remained asymptomatic with stable findings.

Birth trauma-related DMD is rarely detected in adulthood, especially in the absence of visual impairment. The combination of external markers of birth trauma such as auricular deformity and characteristic posterior corneal striae should prompt consideration of this diagnosis. AS-OCT plays a crucial role in confirming and characterizing chronic DMD, particularly when slit-lamp findings are subtle. Previous studies have highlighted that these lesions may remain stable for years but can occasionally result in visually significant astigmatism or corneal decompensation, necessitating intervention.

To the best of our knowledge, this is the first report demonstrating fibrous bridging associated with birth trauma-related DMD using AS-OCT. This case underscores the importance of obtaining a thorough birth history and utilizing AS-OCT to evaluate unexplained posterior corneal changes. Conservative management is appropriate in asymptomatic cases without central corneal involvement, but long-term follow-up is essential to detect potential progression.

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