Diagnosis and Management of Iatrogenic Descemet Membrane Detachment During Cataract Surgery: Case Report
Purpose
To evaluate the treatment options of iatrogenicDescemet’s membrane detachment (DMD)
Methods
A 84year-old woman underwent phacoemulsification surgery due to Grade 3 mature cataract on the right eye. Corneal status, anterior chamber depth and intraocular pressure were within normal limits in the right eye in routine preoperative slit-lamp examination.At the stageof irrigation-aspiration,atearhas occurred in Descemet’s membrane as a result ofthe instrument touching the central cornea.Due to the detachment formation of the tear,the operation was terminated with forming a single, large, full-chamber sterile air bubble in the anterior chamber, flattening the detached membrane on to the stroma and the bubble acting as a tamponade. The patient was discharged with topical steroid-antibiotics and advised to maintain supine position.
Results
On the first postoperativeday, there wasa slightcorneal edema;visual acuitywas0.2andthere wasIOPof 32mmHg.Besidestopical antibiotic andcorticosteroid therapy,topical antiglaucomatous medicationwas added.Because of therapid reabsorbation of theair, there wasan increase incorneal edema on the third postoperative day.Starting fromthe central cornea and extending totheperipheralcornea, Descemet’s membrane detachmentwas observed in anterior segment OCT.On the fourth postoperative day,10%SF6wasinjected intracamerallyand the patient was hospitalized in the supine position.On the fifth postoperative day, DMD was completelyhealed.Increase of IOPorpupillary blockwas not observed. On the postoperative fifteenth day,IOPwas 16mm Hgandrightvisual acuitywas0.6. The cornea remained transparent with no recurrence of detachmentandin the OCT images of the anterior segment, the detachment was completely resolved.
Conclusion
Although DMD isa rare complication, it causes severe and widespread corneal edema.The suspected patients with intense corneal edemacan bediagnosedcorrectly with anterior segment OCT.With proper treatment,goodanatomic and visual results are obtained