Descemet's membrane detachment following uneventful phacoemulsification surgeries: A case report

Late Descemet membrane detachment after uneventful cataract surgery

Purpose

To report 5 patients with late Descemet membrane (DM) detachment after uneventful cataract surgery.

Observations

After a retrospective chart analysis of consecutive patients that developed DM detachment after uneventful cataract surgery, six eyes of five patients were enrolled. In all cases, patients reported good vision initially after cataract surgery. Within days to months, these patients developed late DM detachment with decreased vision. In one patient, the detachment affected both eyes. Filtered air or diluted sulfur hexafluoride were injected in the anterior chamber to tamponade the DM detachment. In five eyes, the cornea cleared after DM reattachment. In two eyes of the same patient, DM reattached spontaneously requiring no further surgical intervention. In one patient, the Descemet failed to reattach and required an endothelial keratoplasty.

Conclusion and importance

Descemet membrane detachment may occur after uneventful cataract surgery. Filtered air or long-lasting intraocular gas may be used to reattach DM. Spontaneous DM reattachment may also occur and surgeons should be aware of this to avoid unnecessary procedures.

Management of Descemet’s Membrane Detachment after Cataract Surgery—A Case Series

Descemet’s membrane detachment (DMD) is an uncommon, vision-threatening, ocular surface complication of cataract surgery. Among several treatment strategies, sulfur hexafluoride (SF6) descemetopexy is the standard of care. Herein, we report three cases of DMD after cataract surgery managed with SF6 descemetopexy, showing different outcomes. Anatomical success was achieved in cases 1 and 2 while intraocular pressure (IOP) was elevated in case 2. In case 3, despite SF6 descemetopexy, recurrent DMD was observed. Due to persistent corneal edema and possible corneal decompensation in case 3, Descemet’s stripping automated endothelial keratoplasty was performed and a clear graft was found at the final visit. In conclusion, descemetopexy with 20 % SF6 is an effective and safe procedure for repairing DMD in most cases. Pupillary block with elevated IOP is another concern and prophylactic peripheral iridectomy is recommended. For recurrent DMDs, repeat descemetopexy could be considered. However, close monitoring is advocated since secondary management, such as endothelial keratoplasty, may be required.

Successful treatment of late onset post-phacoemulsification Descemet's membrane detachment

Purpose:

To present a case with the late-onset post-phacoemulsification Descemet’s membrane detachment that has been treated successfully.

Methods:

Case report.

Results:

A 68-year-old female patient presented with the complaint of decreased vision in her pseudophakic left eye after a 4-week silent post-phacoemulsification period. In the biomicroscopy, corneal oedema was seen to be prominent on the nasal incision side. Anterior segment optical coherence tomography objectively revealed the presence of Descemet’s membrane detachment. Treatment of descemetopexy was applied by injecting 0.3-mL perfluoropropane gas into the anterior chamber. No complication associated with descemetopexy was noticed during recovery. Total Descemet’s membrane detachment reattachment was achieved and perfluoropropane gas resorption from the anterior chamber was completed by the end of 1-month post-injection. The cornea was transparent and best corrected visual acuity increased to 20/20.

Discussion:

DMD is a rare complication following phacoemulsification and this patient had not any preoperative, intraoperative, or postoperative risk factors for DMD.It generally occurs in early-postoperative period and late-onset DMDs have been reported less frequently.The success rates with intracameral gas injections in similar cases have been reported to be 90% - 95%.

Conclusion:

To the best of our knowledge, this is one of the latest onset post-phacoemulsification Descemet’s membrane detachment cases in literature that has been treated successfully. The results of this case showed that descemetopexy is a safe and effective treatment method for late-onset post-phacoemulsification DMD.