LATE DESCEMET MEMBRANE DETACHMENT AFTER UNEVENTFUL CATARACT SURGERY TREATED BY CORNEAL VENTING INCISION WITH GAZ TAMPONADE: A CASE REPORT

Unintentional detachment of the Descemet membrane can occur either during or following intraocular surgery. Various factors and mechanisms may contribute to Descemet membrane detachment that can lead to membrane separation, failure of the endothelial pump, and underlying corneal dystrophies.

The purpose of this poster is to report a case with late Descemet membrane detachment after uneventful cataract surgery and its management

Department of Ophtalmology A- Mohamed V University Ibn Sina Hospital RABAT- MOROCCO

A 59-year-old male patient sought medical attention due to decreased vision in his eye, which occurred 7 days after an uneventful phacoemulsification surgery with intraocular lens implantation. His uncorrected visual acuity was measured at 1/10. A slit lamp examination revealed that the eye displayed corneal edema, which was more prominent in the central area and included the presence of Descemet's folds. The anterior chamber of the eye was deep and free from inflammation, and the intraocular lens remained properly positioned. However, the fundus examination showed hazy details due to the stromal edema. AS-OCT imaging revealed the location of descemet membrane detachment. 

The intraocular pressure was measured at 14 mm Hg in both eyes. Initially, conservative management was employed, which included the use of Dexamethasone  and 5% Hypertonic Saline eye drops without improvement. 

When Descemet membrane detachment was not resolved, another potential option was considered is the use of a corneal venting incision with gas tamponade.

Under local anesthesia, a venting incision was created at the location with the most significant stromal edema. A 14% C3F8 gas was then injected into the anterior chamber of the eye. To prevent further damage to the scrolled Descemet membrane, the tip of the injection cannula was carefully placed on the iris during the injection. Subsequently, corneal massaging was performed in a centripetal manner, moving from the periphery towards the center, using the rounded edges of a blunt forceps.

The gas bubble in the anterior chamber was reabsorbed within six days. After two weeks, the sutures were removed. The cornea regained its transparency, and the patient's visual acuity was fully restored to 9/10 three months following the repair of the Descemet membrane detachment.

Descemet membrane detachment is a significant complication that can arise during surgical procedures that involve manipulation of the anterior chamber of the eye. This problem is most frequently observed in the context of cataract surgery, with the diagnosis being established during the surgical procedure itself in 50% of cases. In some cases the membrane can be repositioned or reattached during the surgery. However, more extensive detachments may require additional procedures or post-operative management to ensure the best possible visual outcomes for the patient.