Delayed-onset descemet membrane detachment after uneventful cataract surgery treated by corneal venting incision with air tamponade: a case report

Abstract

Background: Descemet membrane detachment (DMD) is a significant complication noted during or early after cataract surgery. Review of literature revealed a few cases of delayed-onset DMD with presentation ranging from weeks to months after cataract surgery but most of them were treated with pneumatic descemetopexy and a few ended in penetrating keratoplasty. We report this case, to highlight the usefulness of corneal venting incision with air tamponade in late-onset DMD cases not responding to pneumatic descemetopexy.

Case presentation: A retrospective case review of a 66 year old male who presented with diminution of vision in right eye 17 days after uneventful cataract surgery was done. Visual acuity in this eye was 20/200 at presentation. DMD was noted 3 days later (approximately 3 weeks post-operatively) and Anterior Segment Optical Coherence Tomography & Scheimpflug imaging were done in view of diffuse corneal edema. Pneumatic descemetopexy was attempted thrice (twice with SF6, once with air) over a week's span with limited success at re-attaching the DM. Finally, corneal venting incision with air tamponade was done resulting in egress of supra-descemet's fluid and DM appeared apposed to stroma. Bandage contact lens (BCL) was applied at the end of the procedure. DM was seen attached the next day. Corneal edema cleared completely in 1 week. Best corrected visual acuity (BCVA) at 6 weeks follow-up was 20/30.

Conclusion: Delayed-onset DMD should be considered as a differential diagnosis in cases with late-onset corneal edema post-cataract surgery. Anterior segment Optical Coherence Tomography (AS-OCT) and Scheimpflug Imaging are useful tools in cases with dense corneal edema. Corneal venting incision with air tamponade is an option in cases where methods like pneumatic descemetopexy fail.

Keywords: Air tamponade; Case report; Corneal venting incision; Delayed-onset DMD; Descemet membrane detachment; Expansile gases; Pneumatic descemetopexy; Supra-descemet fluid.

Fig. 1

a Diffuse corneal edema, prominent centrally (POD-17). b Central DMD (POD-20). c SF6 bubble in situ; Superiorly stromal edema present; clear cornea inferiorly (POD-21). d SF6 bubble (second injection), corneal edema with detached DM (POD-22). e Central DMD; decreased corneal stromal edema (POD-27). f Clear cornea (1 week after corneal venting incision with tamponade). g DM attached completely (1 week after corneal venting incision with tamponade)

Fig. 2

a AS-OCT image: Central DMD with increased corneal thickness. b Scheimpflug imaging: Central DMD

Fig. 3

Scheimpflug imaging: Pachymetry at the apex - 856 μm; Thinnest pachymetry - 698 μm