Amputation of Visually Significant Detached Descemet Membrane Flap After Cataract Surgery: Alternative Approach to Complicated Problem
Narrative Responses:
Purpose
To report the methods and outcome of amputation of a detached flap of Descemet’s membrane following cataract surgery as an alternative approach for treatment of a visually significant central corneal Descemet’s detachment.
Methods
One case involving a 68-year-old man presenting with detachment of Descemet’s membrane 6 months following cataract surgery resulting in significant visual disturbance and decrease of visual acuity secondary to pigment clumping and scrolled central detachment. Visante anterior segment ocular coherence tomography (AS-OCT) confirmed detachment and confocal imaging confirmed endothelial cell count was within normal limits before surgery. Pachymetry and slit lamp examination showed no corneal edema. The flap of detached Descemet’s was amputated surgically with reverse Uttratas under viscocohesive. A review of the literature revealed variations in presentations and characteristics of other cases of Descemet’s detachment managed with alternative methods.
Results
Before surgery, the patient’s best corrected visual acuity was 20/50; following the treatment, the visual acuity was 20/30. Anatomically, residual Descemet’s membrane was attached following the procedure as confirmed by slit lamp examination and by AS-OCT and there was no worsening of corneal edema. The anterior segment imaging with AS-OCT, pachymetry and confocal endothelial cell counts assisted in planning surgical approach as well as confirming anatomical success following surgery.
Conclusion
Removal of dislocated Descemet’s membrane is an acceptable approach to management in patients who have centrally located detachments, no corneal edema, and acceptable endothelial cell counts. This case demonstrates improved visual acuity with this procedure as well as the role of anterior segment imaging in managing this difficult postoperative complication.