A Comparative Study between Air Bubble Tamponade Alone versus Air Bubble Tamponade with Internal Fluid Aspiration for Nonplanar Descemet’s Membrane Detachment after Phacoemulsification

Purpose. To compare the efficacy of air bubble tamponade alone versus air bubble tamponade with internal fluid aspiration for nonplanar Descemet’s membrane detachment after clear corneal incision phacoemulsification. Methods. This study is a prospective, intervention, comparative randomised clinical trial, conducted at a private eye centre, Ismailia, Egypt, from March 2019 to March 2020. It contained 30 eyes of 24 patients who had postphacoemulsification nonplanar Descemet’s membrane detachment involving the periphery and the central area of the cornea (>50% of the cornea) with corneal oedema. The patients were divided into two groups: group A: patients with nonplanar DMD affecting the central cornea treated by air bubble tamponade only and group B: patients with nonplanar DMD affecting the central cornea treated by air bubble tamponade augmented by internal fluid aspiration. Trial Registration: This trial was registered at www.pactr.org and the identification number for the registry is PACTR202006612296119. Results. During the 12-month study period, this study included 30 eyes (24 patients) out of 1356 phaco surgeries with postphacoemulsification nonplanar Descemet’s membrane detachment. Six patients had DMD in both eyes, eight patients had DMD in the right eye, and ten patients had DMD in the left eye. All patients have successful surgeries without complications. The calculated incidence rate for visually significant DMD was 2.2% per year. The mean ± SD time interval from cataract surgery to the primary intervention was 4.2 ± 1.1 days. Descemet’s membrane was attached in 56.25% of patients in group A (9 out of 16 eyes) and 92.6% of patients in group B (13 out of 14 eyes) with a minimum of one-month follow-up. Conclusion. Air descemetopexy combined with the internal fluid aspiration demonstrated to be more efficient than air descemetopexy only to treat Descemet’s membrane detachment following phacoemulsification. It should be tried before planning other major surgeries in patients with severe Descemet’s membrane detachment.

Successful Treatment of Post-Phacoemulsification Descemet’s Membrane Detachment Assessed by Anterior Segment Optical Coherence Tomography: A Case Report

Descemet’s membrane detachment (DMD) is a rare but serious complication of phacoemulsification surgery. A small DMD may resolve spontaneously, but extensive DMD often requires intracameral injection of air, nonexpansile gases, or expansile gases. A 92-year-old man who underwent phacoemulsification and aspiration with intraocular lens placement in the right eye had significantly reduced visual acuity, with a hazy cornea after surgery. Anterior segment optical coherence tomography (AS-OCT) examination revealed extensive DMD throughout the cornea. He was treated with intracameral injection of 20% sulfur hexafluoride. As a result, the Descemet membrane was successfully reattached, and the corneal edema resolved. AS-OCT was helpful in confirming the presence and extent of DMD, provided useful information to determine the appropriate treatment, and was useful for monitoring DMD.

Newly Modified Descemetopexy Method in Descemet’s Membrane Detachment and Prognostic Analysis: A Systematic Review

BackgroundTo present a newly modified descemetopexy method and investigate the most determinative factor in the prognosis of Descemet’s membrane detachment (DMD). MethodsThis was a retrospective review of 37 patients (38 eyes) treated with the newly modified descemetopexy method. This surgical method was combined with the vacuum technique to pump supra-Descemet’s fluid. After reviewing and screening, we enrolled 31 patients (32eyes). We evaluated outcomes using the anatomical reattachment of DM [anatomical success (AS)] and the resolution of corneal oedema [functional success (FS)]. Donor characteristics, including sex, age, the presence of diabetes, ocular history, DMD duration, DMD grade, were analysed. Patients were divided into two groups according to whether FS was achieved. Univariate and multi-factor logistic regression analyses were adopted to evaluate factors contributing to the prognosis of DMD. ResultsAS was achieved in 31 eyes (96.9%), and FS was achieved in 21 eyes (65.6%). The univariate analysis showed that both the DMD grade (P=0.029) and DMD duration (P=0.004) affect the prognosis of DMD. The multiple logistic regression analysis indicated that the DMD duration was the dominant factor (P=0.006). No significant difference was found in the DMD grade, sex, age, presence of diabetes, presence of glaucoma or DMD-originating surgery between the two groups.ConclusionsDescemetopexy combined with the vacuum technique can be used to deal with DMD. The DMD duration is the dominant factor affecting the activity of endothelial cells and the final prognosis.

Management of Descemet’s Membrane Detachment after Cataract Surgery—A Case Series

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.