Study on the classification of Descemet membrane detachment after cataract surgery with AS-OCT

Abstract

In this article, the significance of anterior segment optical coherence tomography (AS-OCT) to aid the clinical diagnosis and treatment of Descemet membrane (DM) detachment after phacoemulsification combined with intraocular lens implantation was retrospectively analyzed using 26 patients (26 eyes). The location and scope of DM detachment, its causative factors and the percentage of each detachment type are considered for clinical treatments. Based on the location and scope, the detachment can be divided into three types: (1) simple, (2) symmetrical and (3) complete DM detachment. Simple detachment, confined to the area of surgical incision (detachment range <1/4 corneal area), occurred in 69.20 % of cases (18/26), in which the DM detachment in the anterior lip accounted for 42.30% (11/26) and in the posterior lip accounted for 26.90% (7/26). Symmetrical DM detachment, referring to detachment (1/4 cornea area < detached area <1/2 corneal area) that appeared symmetrically on the surgical incision and the opposite site, accounted for 19.20% (5/26). Complete DM detachment (>1/2 of the corneal area), accounted for 11.50% (3/26). Interestingly, our findings suggest that the DM detachment after phacoemulsification is closely related to the location (simple and symmetrical DM detachment) and the skillfulness (complete DM detachment) of the surgical incision. Therefore, appropriate classification of DM detachment by AS-OCT and wise selection of surgical location can better guide cataract surgery in the future.

Keywords: Descemet membrane detachment; anterior segment optical coherence tomography (AS-OCT); cataract; corneal descension; phacoemulsification.

Figure 1

Simple detachment of Descemet membrane. A. Corneal stromal edema a week after cataract removed by phacoemulsification and IOL implanted after surgery temporal side-cut out. B. Corneal stromal edema after cataract surgery. The detachment of DM was difficult to see under the slit lamp.

Figure 2

Symmetrical detachment of Descemet membrane. A. Corneal stromal edema (++) one week after cataract surgery. The temporal side of the corneal epithelial layer was visible for small blisters. B. Corneal stromal edema (++) after cataract surgery. It was difficult to determine the accurate range of detachment of DM.

Figure 3

Complete detachment of Descemet membrane. The corneal stromal edema (++) and foam-like spots after cataract surgery. Corneal endothelial cells lost function permanently.

Figure 4

AS-OCT results of simple detachment of Descemet membrane. A. Edema and thickening at the temporal side of the right eye shown by AS-OCT. Simple detachment of the DM was present at the anterior incision site (arrow). B. AS-OCT showed mild edema at the corneal stroma layer at the nose site of the left eye. The simple detachment of DM was seen at the anterior incision site (arrow). C. AS-OCT showed stromal edema at the nosal site of the left eye, visible large corneal epithelial blisters and simple detachment of the DM (arrow).

Figure 5

AS-OCT results of symmetric detachment of Descemet membrane. AS-OCT showed corneal stromal edema and thickening, symmetric detachment of DM at the incision and opposite of the incision sites (arrow).

Figure 6

AS-OCT results of complete detachment of Descemet membrane. AS-OCT showed corneal stroma edema and thickening in the left eye, with complete detachment of the DM and the stromal layer, and the DM floated in the anterior chamber (arrow).