Descemet’S Membrane Detachment Following Cataract Surgery: A Case Report And Brief Review

Descemet’s membrane detachment (DMD) is a complication associated with cataract surgery. Most are small, peripheral detachments at the site of corneal incisions and resolve spontaneously after surgery. However, large and central DMD can cause decompensation and opacification of the cornea and permanently impair visual acuity (VA). Treatment options include observation, medical treatment with topical steroids and hypertonic ophthalmic solutions, pneumatic descemetopexy and to consider penetrating keratoplasty, Descemet Membrane Endothelial Keratoplasty (DMEK) or Descemet Stripping Endothelial Keratoplasty (DSAEK).

We present a case report of a patient who underwent left eye (LE) cataract surgery at the Ophthalmology Department of Hospital Pedro Hispano, Matosinhos, Portugal, and developed central-inferior DMD with spontaneous resolution of the corneal edema. Clinical findings, therapeutic measures, clinical evolution and outcome are described. A brief review is presented about the subject.

A functionally monocular 84-year-old female underwent LE cataract surgery. Her past medical history included dementia and macular hole in the right eye. The LE had brunescent cataract with a preoperative VA of 20/63. Trypan Blue dye was used to stain the anterior capsule for capsulorhexis. The phacoemulsification was complicated by anterior chamber instability and collapse. During the irrigation/aspiration phase, an apparent DM flap was inadvertently aspirated. The intraocular lens was placed within the capsular bag. A short pulse of oral prednisolone and topical levofloxacin, bromfenac, dexamethasone phosphate and hypertonic sodium chloride were started. At the first postoperative visit, there was diffuse microcystic corneal edema. The anterior segment OCT confirmed a central-inferior DMD. A conservative approach was chosen considering the patient’s comorbidities and lost flap. The patient was regularly reevaluated and maintained long-term topical treatment with hypertonic solutions and steroids in a slow-tapering regimen. A slow, gradual improvement was observed: VA improved from counting-fingers at month 1, to 20/100 at month 2, 20/40 at month 3, and 20/25 at month 12, with discrete persisting DM folds. Specular microscopy showed a reasonable cellular count (1439 cells/mm²), pleomorphism (coefficient of variation 70%), slightly increased central corneal thickness (577 µm), and no guttae. The patient was satisfied with her final vision.

We believe that migration of nearby endothelial cells led to spontaneous resolution of the corneal edema in our case, as described in other reports. The prognosis of DMD depends not only on the size and position of the DMD but also on the degree of endothelial cell trauma and the function of the remaining endothelial cells. Although most DMD resolve spontaneously after surgery, descemetopexy is the gold standard for the management of persistent, central, or large DMD.