Descemet's membrane detachment after cataract extraction

Abstract

Background: Descemet's membrane detachment is a rare but potentially serious complication of intraocular surgery, most commonly cataract extraction. Small Descemet's membrane detachments typically resolve with topical medical therapy; however, larger detachments require surgical intervention. The most common surgical procedure is a gas-fluid exchange with 20% sulfur hexafluoride (SF6) or 14% perfluropropane (C3F8), which is typically performed at the biomicroscope and is nontoxic to the endothelium.

Case: A 77-year-old man underwent phacoemulsification with a posterior chamber lens implantation by clear corneal incision in the left eye. Visual acuity was 20/40 in the left eye 1 month postoperatively with persistent corneal edema. Visual acuity continued to deteriorate to counting fingers (CF), despite the use of topical hyperosmotics and steroids. At 2 months, a scrolled Descemet's membrane detachment was present from the incision site to the central cornea causing extensive edema. Anterior chamber injection of 14% C3F8 successfully reattached Descemet's membrane. Six weeks after surgery, the gas bubble had resolved, the central cornea was clear, and a curvilinear scar was present from 5:00 to 11:00. Visual acuity remained at CF owing to anterior capsular fibrosis. Anterior YAG capsulotomy improved the vision to 20/40.

Conclusion: Descemet's membrane detachment can have a devastating effect on vision. Timely management is imperative to preserve vision. This case shows the successful repair of Descemet's membrane detachment with 14% C3F8 after unsuccessful topical treatment.