Treatment Of Post Phacoemulsification Descemet’S Membrane Detachment Assessed By Anterior Segment Optical Coherence Tomography: A Case Report

Department of Ophthalmology, Habib Bourguiba University Hospital, Sfax, Tunisia.

A 70-year-old male patient with a history of left eye corneal infection that caused a corneal adherent leukoma as a sequela, underwent successful phacoemulsification with implantation in the bag. Undetected during surgery, the detachment was found the day after surgery when the patient had significant corneal edema. The best corrected visual acuity (BCVA) was 1/30. AS-OCT examination showed an extensive nonplanar DMD with rupture and inversion of the Descemet flap. The DMD originated at the level of the leukoma and involved the visual axis. The CCT was 960 µm. The decision was to monitor the patient without intervening. One week later, AS-OCT showed the same aspect of DMD with a CCT of 1078 µm. The patient has been managed with air descemetopexy. An air bubble (0.2 ml) was injected into the anterior chamber opposite the inverted flap to straighten it. The patient remained in the supine position for 2 hours. One week afterward, DMD improved and CCT was at 921 µm, whereas two weeks post tamponade, Descemet membrane began to reattach and CCT was at 826 µm. Complete resorption of the supra-Descemet's fluid was obtained 3 weeks post-intervention with CCT at 698 µm and clear cornea. Best-corrected visual acuity improved to 20/40.