Out-Of-The-Box Management Of Persistent Descemet Membrane Detachment After Phacoemulsification "If You Miss It , It Will Mess With You "

To report an early postoperative Descemet membrane detachment (DMD) after routine phacoemulsification in a monocular patient and describe a successful “out-of-the-box” approach after repeated failure of standard intracameral air descemetopexy.

The case was managed at a tertiary academic ophthalmology center.

A 75-year-old hypertensive female, a monocular patient, presented with gradual painless diminution of vision in the right eye for three years. Preoperative visual acuity was hand movements with accurate projection. Examination showed a dense brown cataract with no fundus view; B-scan ultrasonography confirmed a normal posterior segment. Uneventful cataract surgery was performed.

On postoperative day 1, only the superior one-third of the cornea was clear, with moderate corneal edema elsewhere. Anterior segment OCT confirmed Descemet membrane detachment. Intracameral air injection was planned and performed but failed to reattach the membrane. A repeat attempt by a senior consultant also failed. Re-evaluation suggested persistent fluid trapped between Descemet membrane and posterior stroma (suspected entrapped aqueous) preventing tamponade. The patient was taken back to the operating room; a targeted corneal puncture was performed to access the pre-Descemet space and drain the trapped fluid, followed immediately by intracameral air injection. Descemet reattachment was achieved. At one month, the cornea was clear with improved visual acuity.

Early postoperative corneal edema after cataract surgery—especially in monocular patients—should prompt active exclusion of DMD using anterior segment OCT. If standard descemetopexy fails, reassess for persistent interface fluid that can prevent reattachment; drainage of trapped fluid prior to repeat air injection may be decisive. Escalation to senior input and timely re-intervention can optimize outcomes.
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