Successful Treatment Of Descemet's Membrane Detachment Post Cataract Surgery
Published 2023 - 41st Congress of the ESCRS
Reference: PP07.11 | DOI: 10.82333/5ges-yf23
Authors: Maria Del Pilar Lucena* 1 , Fernando Ariel Garcia 1
1CATARACT,CEO OFTALMOLOGIA,ROSARIO,Argentina
Descemet's membrane detachments (DMD) are relatively common after cataract surgery and most do not require any treatment. However, if large DMD are not treated appropriately, significant visual morbidity can ensue.
A small DMD may resolve spontaneously, but extensive DMD often requires intracameral injection of air, nonexpansile gases, or expansile gases.
We present a case of DMD successfully treated with air bubble injection in office.
Case Presentation
A 63-year-old male patient underwent superotemporal clear-corneal phacoemulsification with posterior chamber IOL implantation in the left eye. The surgery was performed successfully, and the IOL was implanted in the capsular bag.
The patient presented with corneaL edema after the surgery and DMD. We decided to perform anterior chamber tamponade with air under topical anesthesia on postoperation day 15.
Patient’s intrapalpebral area was sterilized with drops of povidone-iodine solution. An air bubble possessing 90% of the anterior chamber was injected in the anterior chamber at the slit lamp with the use of a 30-gauge needle on a 3-mL syringe filled with air. Dilating drops were used to prevent any pupillary block from air bubble. The patient stayed in a supine position for the 10 minutes, and then we partially removed the air in the anterior chamber.
The patient was advised to stay in a supine position as much as reasonably possible to allow the air bubble to press the Descemet membrane to the posterior corneal stroma. One week after, Descement's membrane was reattached, corneal edema resolved, and the visual acuity improved to 20/25.
Mackool and Holtz[classified DMD into planar and nonplanar. Detachments of the DM are classified as planar when there is ≤1 mm separation of the DM from its overlying stroma while nonplanar DMD exceed 1 mm of separation. They concluded that planar detachment has the better prognosis then nonplanar type. In another classification, Samarawickrama et alpropose classifying DMD into 2 categories: peripheral and central. In cases where the visual axis is involved, they suggest early intervention with air tamponade.
In our case, the patient presented a planar DMD compromising the visual axis so we decided to tamponade with air bubble in office.
Descemet membrane detachment is a potential complication of cataract surgery that could be detrimental for patients’ vision. Most of the cases resolve spontaneously, especially when the detachment has small dimensions. Corneal persistent edema and its progressive increase after cataract surgery should be an indicator of possible detachment of the Descemet membrane after exclusion of intraocular pressure and other factors.