Purpose of reviewDescemet's membrane detachment (DMD) is commonly encountered after intraocular surgery and ocular trauma. Although its occurrence has been known for a long time, the disease course and its optimal management is not yet fully understood. This review aims to present an update on curre

Update on diagnosis and management of Descemet's membrane detachment.

Descemet membrane detachment (DMD) is a significant complication noted during or early after cataract surgery. Review of literature revealed a few cases of delayed-onset DMD with presentation ranging from weeks to months after cataract surgery but most of them were treated with pneumatic descemetopexy and a few ended in penetrating keratoplasty. We report this case, to highlight the usefulness of corneal venting incision with air tamponade in late-onset DMD cases not responding to pneumatic descemetopexy. A retrospective case review of a 66 year old male who presented with diminution of vision in right eye 17 days after uneventful cataract surgery was done. Visual acuity in this eye was 20/200 at presentation. DMD was noted 3 days later (approximately 3 weeks post-operatively) and Anterior Segment Optical Coherence Tomography & Scheimpflug imaging were done in view of diffuse corneal edema. Pneumatic descemetopexy was attempted thrice (twice with SF6, once with air) over a week’s span with limited success at re-attaching the DM. Finally, corneal venting incision with air tamponade was done resulting in egress of supra-descemet’s fluid and DM appeared apposed to stroma. Bandage contact lens (BCL) was applied at the end of the procedure. DM was seen attached the next day. Corneal edema cleared completely in 1 week. Best corrected visual acuity (BCVA) at 6 weeks follow-up was 20/30. Delayed-onset DMD should be considered as a differential diagnosis in cases with late-onset corneal edema post-cataract surgery. Anterior segment Optical Coherence Tomography (AS-OCT) and Scheimpflug Imaging are useful tools in cases with dense corneal edema. Corneal venting incision with air tamponade is an option in cases where methods like pneumatic descemetopexy fail.

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Delayed-onset descemet membrane detachment after uneventful cataract surgery treated by corneal venting incision with air tamponade: a case report.

A 51-year-old male who had undergone phacoemulsification in his left eye 11 months prior presented with complaint of sudden onset of blurred vision in the same eye. Review of his clinical course, slit-lamp exam, pachymetry, and specular endothelial microscopy led to the diagnosis of acute hydrops caused by Descemet’s membrane dehiscence at the site of the incision. He was initially managed with medical treatment and observation. In the subsequent months of follow-up, the corneal edema and the patient’s visual acuity did not improve. Intracameral gas injection was performed 7 months after presentation, but because of persistent corneal edema and nonattached Descemet’s membrane, penetrating keratoplasty was performed. Histopathologic examination confirmed the diagnosis. The patient has had a clear corneal graft since then. Although Descemet’s membrane detachment is a rather common complication after intraocular surgery, its unusually delayed presentation can also occur, and should not be confused with pseudophakic bullous keratopathy. Many mechanisms have been studied for the development of early tears and detachments after cataract surgery, but little is known about late presentations. The authors explore possible causes, and highlight the importance of instructing patients to avoid eye rubbing and any other type of trauma to the cornea after intraocular surgery.

/pdf/unusually-delayed-presentation-of-persistent-descemet-s-2nazr1x544.pdf

Unusually delayed presentation of persistent Descemet’s membrane tear and detachment after cataract surgery

Purpose To report a case series of 4 patients with Descemet membrane detachment (DMD) after undergoing femtosecond laser-assisted cataract surgery incisions. Methods Case report. Results DMD was noted at the secondary incision (n = 2) or at the main incision (n = 2). All the secondary incision and 1 main incision DMD were resolved with intraoperative maneuvers. Delay in recognizing DMD intraoperatively at the principal incision in 1 case led to inadvertent aspiration of a part of it and persistent postoperative corneal edema. This complication was handled with Descemet membrane endothelial keratoplasty 1 month after initial surgery. Conclusions DMD can occur after femtosecond laser-assisted cataract surgery, although it is a rare complication as it is in traditional phacoemulsification. The surgeon must be prepared to recognize it, manage it intraoperatively, and treat it postoperatively to reduce the risk of permanent damage to the eye.

Descemet Membrane Detachment in Femtosecond Laser-Assisted Cataract Surgery.

Descemet's membrane detachment is an important reason for corneal endothelial decompensation after intraocular surgery. During cataract surgery, it is an unusual complication. We report a case of Descemet's membrane detachment in which approximately 60% of Descemet's membrane (DM) involving approximately the upper two-thirds of the cornea was torn out during a routine phacoemulsification. It caused diffuse corneal edema and blurred vision in the 2 months following the surgery. Topical prednisolone acetate (1%) and sodium chloride (5%) had been used for treatment, with slow improvement in the patient's symptoms and vision. Interestingly, the cornea regained clarity 2 months after surgery without further surgical treatment.

/pdf/a-case-of-descemet-s-membrane-detachments-and-tears-during-473cajiv31.pdf

A case of Descemet’s membrane detachments and tears during phacoemulsification

We report the case of a 76-year-old man who developed a late-onset Descemet's membrane detachment (DMD) 5 months after uncomplicated cataract surgery. Despite two air tamponade procedures that initially appeared successful, the DMD continued to return. After careful examination it was found that a surgical entry wound may have been scarred open (fish-mouthing), which continually promoted Descemet's membrane to detach. Excision of the abnormal scar led to an almost complete resolution of the DMD. To our knowledge, this is the first report of a pathological (fish-mouthing) entry wound causing a persistent, late DMD. We discuss the reasons why the management of late DMDs requires careful consideration.

Late-onset persistent Descemet's membrane detachment following uncomplicated clear corneal incision cataract surgery.

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Late-onset persistent Descemet's membrane detachment following uncomplicated clear corneal incision cataract surgery.