EnVision Summit 2026: A case study involving Descemet membrane detachment

Nicole Bajic, MD, a surgeon at the Cleveland Clinic Cole Eye Institute, outlined a case study involving Descemet membrane detachment occurring in the setting of focal canaloplasty using the Streamline Surgical System that she presented in part of the glaucoma track at EnVision Summit 2026. Descemet membrane is an important inner layer of the cornea, and its detachment is a significant and potentially vision-threatening complication. Bajic emphasized that this type of complication is not typically expected with focal canaloplasty, especially when performed with the Streamline device. This makes the case clinically notable and somewhat atypical.

She contrasts this situation with what is more commonly seen in glaucoma surgery: Descemet membrane detachment is classically associated with 360-degree canaloplasty, not focal canaloplasty. In a 360º canaloplasty, the entire Schlemm’s canal is treated, and the procedure can generate increased pressure within Schlemm canal. When that pressure becomes excessive, it can disrupt or “violate” the trabeculo-corneal junction—the area where the trabecular meshwork meets the cornea. This disruption can, in turn, lead to detachment of Descemet membrane.

What makes her case compelling is that a similar complication—Descemet membrane detachment—has occurred without the usual setting of a 360º procedure. Instead, it followed a focal canaloplasty with the Streamline device, which is generally not associated with this particular adverse effect. By highlighting this discrepancy between expected and observed outcomes, Bajic positioned the case as an unusual, instructive example that may have implications for how surgeons think about canal-based glaucoma procedures, intra-canal pressure dynamics, and risk counseling for patients.

Bajic expressed genuine enthusiasm about contributing to EnVision, framing her presentation as part of a broader effort to understand and refine glaucoma surgery techniques.