Late Descemet Detachment After Uneventful Cataract Surgery

To report a bilateral late detachment of the Descemet membrane after unevenftul cataract surgery.

Private practice

A 65-year-old female presented 6 weeks after cataract surgery being performed in both eyes one week apart each other elsewhere. She enjoyed great vision for two weeks after surgery, however, she developed a rapid decline in her vision in both eyes with the right eye more significantly affected. She had been treated for herpetic keratitis with valacyclovir with no improvement. On examination, it was noted a severe detachment of the Descemet membrane (DM) with gross overlying corneal edema, more important in the right eye. The detachment in the left eye was limited to the region next to the temporal incision. It was decided to reposition the DM with injection of filtered air in the AC. Despite an initial improvement, the membrane re-detached a few days later. However, the left eye (which was left untouched) had spontaneously resolved the detachment and cleared the edema. We monitored the right eye for a few months and, to our surprise, there was a total spontaneous resolution of the DM detachment with improvement of vision.

Descemet membrane detachment may happen later in the postoperative period even after uneventful cataract surgery. Bilateral involvement is possible. Reposition of the Descemet membrane with injection of filtered air or gas in the anterior chamber can be considered. Endothelial keratoplasty is also a possible treatment for unresponsive cases. However, surgeons must be aware that spontaneous resolution is possible and the need for a more invasive treatment should be carefully evaluated.