Cryotherapy for impending spontaneous prolapse of the

eye balls : Case reports

Gede Pardianto
Sumatera Eye Center, Medan, Indonesia

Abstract
Purpose
: To report the efficacy of cryotherapy for descemetocele to avoid any
kinds of spontaneous prolapse of the eye balls.
Method
: 7 patients with any case of severe descemetocele with high potentially
spontaneous prolapse of the eye balls underwent with any cryotherapy procedures.
Patients had been controled at first day, 1 week, 2 weeks and 1 month pos operatively.
Any results and progressions had been recorded. All patients had good outcomes on size
of descemetocele, also better corneal shape and strength formations.
Results
: In these reports, any cryotherapy procedures can promote formation of
cycatrix on cornea wall as the surface of cornea becomes thicker and stronger and finally
reconstruct the shape of the eye ball. The spontaneous prolapse of the eye balls could be
avoided and any evisceration surgeries were not necessary to perform.
Conclusion : Cryotherapy has good results for descemetocele management to avoid
spontaneous prolapse of the eye balls.
Keywords

: Descemetocele, Spontaneous prolapse of the eye balls, Cryotherapy

Introduction
Corneal ulcer is a cause of severe sight threatening. Some of corneal ulcer provoke any
loss of epithelium and stroma, even make any corneal perforation and spontaneous
prolapse of the eye ball.

Case reports
Case 1
A wowan 65 years old with psuedophakic left eye was suffering corneal ulcer. Location
was at near central with 5 mm diameter. Descemetocele occur and iris moved anteriorly
as defend mechanisms. She did doctor shopping and accepted any suggestions for
evisceration surgery. Lately she went to our clinics and underwent cryotherapy. We
performed 4 points with duration 10 seconds each of 60 degrees sub zero cryopexy. Any
antibiotics such as Levofloxacine Eye Drops had been given 1 drop hourly. Patient also
accepted 500 mg Mefenamic Acid 3 times daily. Patient was controlled at day one, one
week, two weeks and one moth post operatively. The procedure showed progress after
one week controlled and completely showed good result at two weeks post operative with
cycatix appearance on formerly location of descemetocele, corneal shape was
reconstructed, iris was back to its position and any prolapse was not occur. The
evisceration procedure was not necessary anymore.

Picture 1. Pre-operative appearance

Picture 2. One month post-operative appearance

Case 2
40 years old man suffered a severe 10 X 9 mm diameter of descemetocele following 2
weeks of neglected corneal ulcer on right eye. This condition followed by bulging of iris
and lens those touch each others anteriorly attached to the descemetocele. Spontaneous
prolapse of the eye ball would be no longer and might need a following evisceration
procedures to manage this condition. We performed 10 points cryopexy on the
descemetocele, with duration 10 seconds each of 80 degrees sub zero. Any antibiotics
such as Levofloxacine Eye Drops had been given 1 drop hourly. Patient also accepted
750 mg Ciprofloxacine and 500 mg Mefenamic Acid 3 times daily orally. Patient was
controlled at day one, one week, two weeks and one moth post operatively. The
procedure showed progress after one week controlled and completely showed good result
at one month post operative with cycatix appearance on formerly location of
descemetocele, corneal shape was reconstructed, iris was back to its position and any
prolapse was avoide. The evisceration procedure was not necessary anymore.

Picture 3. Pre-operative appearance

Picture 4. One month post-operative appearance

Case 3
47 years old man suffered a 11 X 10 mm diameter of descemetocele on his left eye
following a suspect fungi corneal ulceration. He was treated by combination of
antibiotics, anti fungi and anti viral for 3 weeks. This condition followed by bulging of
iris and lens those touch each others anteriorly attached to the descemetocele. The
condition showed an impending prolapse of the eye balls. Cryotherapy was performed on
8 points perpendicularly to the descemetocele, each procedure took 10 seconds of
duration with 80 degrees sub zero. Combinations of drugs still be given. Patient was
controlled at day one, one week, two weeks and one moth post operatively. After one
weeks patient showed better conditions with reconstructed corneal shape, thickening
corneal surface with cicatrix process and prolapse of the eye ball could be avoided.

Picture 5. Pre-operative appearance

Picture 6. One month post-operative appearance

Case 4
59 years old woman suffered a 11 X 10 diameter of descemetocele by corneal ulcer due
to contact injury to sheeds of rise on her right eye. She was treated by combination of
antibiotics, anti fungi and anti viral for 4 weeks. This condition followed by bulging of
iris and lens those touch each others anteriorly attached to the descemetocele. The
condition showed an impending prolapse of the eye balls. Cryotherapy was performed on
10 points perpendicularly to the descemetocele, each procedure took 10 seconds of
duration with 80 degrees Celcius sub zero. Combinations of drugs still be given until 3
weeks post operatively. Patient was controlled at day one, one week, two weeks and one
moth post operatively. After one weeks patient showed better conditions with
reconstructed corneal shape, recovery iris bulging, thickening corneal surface with
cicatrix process and prolapse of the eye ball risk can be decreased.

Picture 7. Pre-operative appearance

Picture 8. Firs day post-operative appearance

Picture 9. Two weeks post-operative appearance

Case 5
A 27 years old young man suffered a corneal ulcer cum hypopion with descemetocele on
right eye. Patient accepted any medication such as antibiotic and anti fungi. The patient
underwent any minus 60 degrees Celcius cryopexy by six points on his descemetocele.
Control performed at firs day, one week, two weeks and one month post operatively.
After two weeks post surgery, the cornea relieved from descemetocele and eye become
stable as prolapse of the eye ball could be avoided.

Picture 10. Pre-operative appearance

Picture 11. Two weeks post-operative appearance

Case 6
A18 years old young man suffered a descemetocele due to neglected sharp trauma with
partial thickness defect of the cornea. Spontaneous prolapse of the eye ball was very
potential at that moment. He underwent 4 points of 60 degrees sub zero Celcius
cryopexy. He took control at firs day, one week, two weeks and one month after surgery.
The descemetocele was relieved at two week post operatively and the shape of cornea
became really better at one month after surgery. The cryotherapy saved his eye ball.

Picture 12. Pre-operative appearance

Picture 13. Two weeks post-operative appearance

Picture 14. One month post-operative appearance

Case 7
A 48 years old woman suffered a corneal ulcer with descemetocele and mucopurulent
secrets on right eye. She accepted any medications including antibiotics and anti fungi.
She underwent cryopexy by 2 points of 60 degrees sub zero Celcius. She took control at
first day, one week, two weeks and one month after surgery. The descemetocele was
relieved at one week post operatively and the shape of cornea became much better at one
month after surgery.

Picture 15 : Pre-operative appearance

Picture 16 : One month post-operative appearance

Methods of surgery
The cryotherapy procedure should be carried out under controlled aseptic
conditions, which include the use of sterile gloves, a sterile drape, and a sterile
eyelid speculum (or equivalent).
Adequate anesthesia topically 0.5% Tetracain Eye Drops
A broad-spectrum microbicide should be given prior to the procedure
Povidone iodine 5%.
Perform 60 to 80 degrees sub zero cryopexy perpendicularly to corneal surface for
duration about 10 seconds
Use of antibiotics should not be interrupted or stopped
Sometimes patching is needed due to the conditions of descemetocele
Monitoring may consist of a check for
Freezing and thawing, do not pull the cryo probe until thawing process is
complete
All pains caused by the procedures should be relieved
Biomicroscopy one day, one week, two weeks and one month following
the procedure.
Patients should be instructed to report any symptoms suggestive of
endophthalmitis without delay.