Pseudophakic Corneal Edema Caused By Descemet Membrane Detachment

Descemet membrane detachment (DMD) after cataract surgery is rare and most cases do not require any secondary surgical intervention and can be treated conservatively. However, cases which large descemet detachments need to be recognized and treated appropriately. Detection of descemet membrane detachment is difficult by slit lamp examination due to corneal edema. The advent of anterior segment imaging using OCT technology has made diagnosing pathologies of the anterior segment accurate and time efficient and has proven as an invaluable tool to guide decision making.

University Eye Clinic Heidelberg, Heidelberg, Germany

A 71-year-old patient presented after complicated cataract surgery 1 month prior with decreased visual acuity and cloudy vision on the right eye. On examination, best corrected visual acuity was 0.05 (decimal). Slit-lamp examination revealed diffusely epithelial and stromal edema with descemet folds centrally and descemet membrane detachment nasally. Assessment of the posterior segment was not possible due to diffusely corneal edema. Ultrasonography showed a fully attached retina. Anterior segment OCT (Anterion, Heidelberg Engineering, Heidelberg, Germany) was performed to better evaluate the extent of DMD. This revealed a significantly centrally detached descemet membrane with protrusion into the anterior chamber. We performed an anterior chamber air tamponade under topical anesthesia. Pre-operatively, two YAG-Iridotomies were performed to avoid angle closure glaucoma. The air was injected and the anterior chamber was filled completely with air for one hour. After one hour the air bubble was reduced to 80%  anterior chamber volume.  Postoperatively, the patient was advised to remain in a supine position. After the first day postoperatively, central corneal edema decreased, visual acuity improved to 0.50 (decimal), IOP was at 10mmHg and descemet membrane was fully attached on anterior segment imaging. On the second postoperative day, visual acuity further improved to 0.63 (decimal), with no central corneal edema and normal IOP.

This case report showed that using an anterior segment OCT device can help determining the extent of descemet membrane detachment and guide appropriate management of descemet membrane detachment. This case showed that severe case of descemet membrane detachment after complicated cataract surgery can be treated with anterior chamber air tamponade with significant reduction of corneal edema and improvement of visual acuity. Thus, descemet membrane endothelial keratoplasty is not always needed in these cases.