Inadvertent descemetorhexis and Descemet's membrane detachment after cataract surgery – Reendothelialization after C3F8 descemetopexy: A case report and review of literature

Descemet’s membrane detachment (DMD) is an uncommon, vision-threatening, ocular surface complication of cataract surgery. Among several treatment strategies, sulfur hexafluoride (SF6) descemetopexy is the standard of care. Herein, we report three cases of DMD after cataract surgery managed with SF6 descemetopexy, showing different outcomes. Anatomical success was achieved in cases 1 and 2 while intraocular pressure (IOP) was elevated in case 2. In case 3, despite SF6 descemetopexy, recurrent DMD was observed. Due to persistent corneal edema and possible corneal decompensation in case 3, Descemet’s stripping automated endothelial keratoplasty was performed and a clear graft was found at the final visit. In conclusion, descemetopexy with 20 % SF6 is an effective and safe procedure for repairing DMD in most cases. Pupillary block with elevated IOP is another concern and prophylactic peripheral iridectomy is recommended. For recurrent DMDs, repeat descemetopexy could be considered. However, close monitoring is advocated since secondary management, such as endothelial keratoplasty, may be required.

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Anatomic and Visual Outcomes of Descemetopexy in Post-Cataract Surgery Descemet's Membrane Detachment

Ophthalmology ◽

10.1016/j.ophtha.2012.12.043 ◽

2013 ◽

Vol 120 (7) ◽

pp. 1366-1372 ◽

Cited By ~ 27

Author(s):

Rajat Jain ◽

Somasheila I. Murthy ◽

Sayan Basu ◽

Md. Hasnat Ali ◽

Virender S. Sangwan

Keyword(s):

Cataract Surgery ◽

Visual Outcomes ◽

Descemet’S Membrane Detachment ◽

Descemet's Membrane ◽

Descemet’S Membrane

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A retrospective study on the incidence of post-cataract surgery Descemet’s membrane detachment and outcome of air descemetopexy

British Journal of Ophthalmology ◽

10.1136/bjophthalmol-2016-309766 ◽

2017 ◽

Vol 102 (2) ◽

pp. 182-186 ◽

Cited By ~ 7

Author(s):

Annamalai Odayappan ◽

Narayana Shivananda ◽

Seema Ramakrishnan ◽

Tiruvengada Krishnan ◽

Sivagami Nachiappan ◽

...

Keyword(s):

Retrospective Study ◽

Cataract Surgery ◽

Functional Outcome ◽

Major Surgery ◽

Extracapsular Cataract Extraction ◽

Female Ratio ◽

Descemet’S Membrane Detachment ◽

Surgical Trainees ◽

Descemet's Membrane ◽

Descemet’S Membrane

PurposeTo study the anatomic and functional outcome of air descemetopexy in postcataract surgery Descemet’s membrane detachment (DMD).DesignRetrospective study.MethodsSetting: Institutional.Study population: Records of 112 patients who underwent air descemetopexy for postcataract surgery sight-threatening DMD at Aravind Eye Hospital, Pondicherry, between January 2013 and December 2015 were studied.Main outcome measures: Anatomical outcome refers to reattachment of the Descemet’s membrane (DM). Functional outcome was given by the best-corrected visual acuity.ResultsThe mean age was 66.47±8.46 (SD) years, the male to female ratio was 45:67. The incidence of DMD was more in extracapsular cataract extraction (0.26%) and manual small incision cataract surgery (0.11%) than phacoemulsification (0.04%) (p=0.005 and p<0.0001). DMD was more common among surgical trainees (0.17%) than consultants (0.07%) (p≤0.0001). After primary air descemetopexy, 78 (71%) out of the 110 patients had DM reattachment. The complications noted after descemetopexy include persistent DMD (21.8%), corneal decompensation (7.3%), appositional angle closure (18%), pupillary block with air (2.7%) and uveitis (2.7%). Age, sex and timing of intervention did not influence the reattachment rate. Fifteen patients underwent repeat air descemetopexy for persistent DMD among whom nine (60%) had successful reattachment. Almost 75% of patients had vision better than 6/18 1 month after anatomically successful descemetopexy.ConclusionAir descemetopexy is a safe and efficient modality of treatment of DMD and should be tried even in patients with severe DMD before planning a major surgery like endothelial keratoplasty.

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