Clinical profile and outcomes of descemetopexy in descemet membrane detachment (DMD) post-cataract surgery

To identify the preoperative risk factors, type of cataract surgery, cataract grade, and final visual outcome in patients undergoing descemetopexy for DMD. This was a retrospective study in which records of patients who underwent descemetopexy with either air or 20% sulfur hexafluoride (SF6) between 1st July 2014 and 30th June 2017. Grade of cataract, type of surgery, visual outcomes, and site of DMD were recorded.The mean age of the patients was 63.21 ± 5.8 years. Of the total 23 cases undergoing descemetopexy, 20 cases (87%) were after manual small incision cataract surgery (MSICS) and three cases (13%) were post phacoemulsification. The mean duration of presentation with a detachment was 13.03± 10.9 days (1-40 days). The most common types of DMD were total (34.8%) followed by temporal (30.4%) and superior (26.1%). Two patients (8.6%) obtained LOGMAR visual acuity (VA) of 0.0 and 5 of 23 patients (21.7%) achieved LOGMAR VA 0.3 after descemetopexy. Reattachment rates were 87% and three cases had reintervention. : This study identifies mature cataract and pre-existing corneal pathology as major risk factors for DMD during cataract surgery. DMD can be treated effectively and good visual outcome after successful descemetopexy.

Delayed Perforation of an Intrastromal Corneal Ring Segment into the Anterior Chamber: A Case Report and Review of the Literature

Intrastromal corneal ring segments (ICRSs) are an effective treatment for stabilizing and normalizing corneal shape in patients with keratoconus and other corneal ectasias. Intraoperative segment perforation through the corneal endothelium into the anterior chamber (AC) is an uncommon but known complication. However, perforation into the AC postoperatively is an exceedingly rare complication with only 3 reported cases in the literature. One case was due to Descemet membrane detachment and another due to ocular trauma. In the third case, the mechanism for perforation was unclear. We present the fourth case of delayed ICRS perforation due to silent migration through the endothelium into the AC. We also present all reported cases in the literature of intraoperative and postoperative perforation into the AC.