Management And Outcomes Of Descemets Membrane Detachment During Cataract Surgery

The purpose of the study is to analyse the outcomes of surgical management of Descemet membrane detachment ( DMD) as a complication during cataract surgery by descemetopexy with air, C3F8 or sutures. The type of surgery, extent of DMD, the surgical intervention and final visual outcome along with success of reattachment and demographics were analysed.

Community based cataract  training Centre of a tertiary care hospital

It is a retrospective case review of the records of the 30 patients who had undergone cataract surgery in the training Centre between 2012 and 2021 with  more than 4 clock hours of DMD involving the visual axis, causing corneal edema that needed surgical intervention with a follow-up of at least six weeks. The demographics, type of cataract surgery- phacoemulsification (PE), Manual Small incision cataract surgery by Blumenthal technique  (SICS) or Extracapsular cataract extraction (ECCE), extent of detachment. nature of the DMD, the intervention done, number of attempts needed for successful reattachment, visual recovery and the type of descemetopexy done for  reattachment were evaluated

Male : female ratio was 13:17. Age was between 54 and 92 years. 10 cases occured in PE, 16 in SICS and 4 in ECCE. 15 of them had DMD of > 8 clock hours.  All ECCE cases had total DMD. 21 eyes had non- planar DMD. 22 had tears and scrolls of which only 3 were in the planar DMD. 19 of them were detected intraop,  5 on day 1 and rest by a week ( after the corneal edema reduced). Air was used in 12/19 eyes. Overall C3F8 was used in 20/30 eyes. Snellen's Visual acuity improved to 6/9 or better in 20/30 cases and 6/18 or better in 83% eyes. All achieved anatomical apposition but two had persisting corneal edema. Cause for <6/18 vision was one each of high astigmatism, diabetic retinopathy and  corneal scar and persistent corneal edema in 2 cases 

Descemet membrane detachment is a rare but disastrous complication of cataract surgery. Early detection and appropriate management can result in good visual recovery. As all except one had DMD involving the inferior half of the cornea, 70% had non planar separation and >70% had tears and scrolls, C3F8 was the most successful tool for descemetopexy in our study.