Descemet Membrane Detachment After Uncomplicated Cataract Extraction

Descemet membrane detachment (DMD) is an uncommon complication following intraocular surgery or trauma, causing severe stromal edema from corneal endothelial dysfunction. It has been diagnosed after a wide variety of intraocular surgeries, such as cataract extraction, keratoplasty, vitrectomy, and trabeculectomy. Etiological factors include incision site, equipment, and surgeon experience. A minor flap of detachment—a loss of attachment between descemet membrane and anterior stroma—may be seen at the end of cataract surgery, although it rarely progresses to a complete detachment. Here we report a case of DMD diagnosed thirteen days after uncomplicated phacoemulsification, managed with intracameral gas injection.

Private ophthalmology clinic with high-volume surgeons in Copenhagen, Denmark

A 68-year-old male was referred for consideration of cataract surgery in both eyes, due to gradual reduction in visual acuity at all distances and increased glare and halos during nighttime. There was no history of previous ocular disease or surgery, and the patient presented with low myopia and best-corrected visual acuity below 6/12 OU. The diagnosis of cataract was confirmed in both eyes, along with an epiretinal membrane in the right eye.
Both eyes underwent uncomplicated phacoemulsification four weeks apart. The first eye (OD) had an uneventful recovery, reaching planned emmetropia and visual improvement within the first few days after surgery. Three days after surgery on the second eye (OS), the patient presented with visual acuity <6/60, moderate stromal and epithelial edema, and extensive folds in the descemet membrane. A conservative approach was chosen, but at thirteen days postoperatively there was no improvement in subjective or objective findings. Scheimpflug imaging and AS-OCT scanning revealed a superiorly positioned detachment of the descemet membrane. After referral to the nearest ophthalmology department and treatment with an intracameral gas injection of perfluoropropane (C3F8), the patient was found to have fully recovered from DMD at six weeks post-phacoemulsification.

The causes for DMD are still uncertain; therefore, the treatment of choice may vary. However, surgical skills, technique, and equipment during ocular surgery seem to play a role in its prevalence. With the increased use of anterior segment OCT, more cases might be diagnosed, and DMD could be considered a differential diagnosis for corneal edema after intraocular surgery. Taking clinical finding into consideration, the treatment of choice should be observation combined with intracameral gas injection, and in severe cases without improvement, a surgical intervention might be considered.