Late-onset persistent Descemet's membrane detachment following uncomplicated clear corneal incision cataract surgery

Abstract

We report the case of a 76-year-old man who developed a late-onset Descemet's membrane detachment (DMD) 5 months after uncomplicated cataract surgery. Despite two air tamponade procedures that initially appeared successful, the DMD continued to return. After careful examination it was found that a surgical entry wound may have been scarred open (fish-mouthing), which continually promoted Descemet's membrane to detach. Excision of the abnormal scar led to an almost complete resolution of the DMD. To our knowledge, this is the first report of a pathological (fish-mouthing) entry wound causing a persistent, late DMD. We discuss the reasons why the management of late DMDs requires careful consideration.

A case of Descemet’s membrane detachments and tears during phacoemulsification

“… 12 DMD has also been reported in Descemet membrane endothelial keratoplasty and deep anterior lamellar keratoplasty. 13 , 14 Several mechanisms have been implicated in the etiology of DMD, such as a shallow anterior chamber, 1 use of blunt microkeratomes, 15 shelved and/or anteriorly placed incisions, 16 , 17 engagement of the DM during intraocular lens implantation, 18 the inadvertent injection of saline into the space between the deep stroma and the DM. 12 …”

“…Descemet’s membrane detachment (DMD) is often attributable to cataract surgery. 1 – 3 Various types of DMD can cause corneal endothelial dysfunction. In 1928, DMD was first described by Samuels; 4 he reported three patients with DMD after iridectomy.…”

Unusually delayed presentation of persistent Descemet’s membrane tear and detachment after cataract surgery

“…Wong et al reported a case of a patient who developed a Descemet’s detachment 8 months after THC:YAG (thulium, holmium, chromium-doped yttrium aluminum garnet crystal) laser sclerostomy 1. Stewart et al reported a case of a Descemet’s detachment that occurred 5 months after uncomplicated cataract surgery 2. To our knowledge, this is the first report of delayed Descemet’s tear and detachment occurring 11 months after cataract surgery.…”

Persistierendes Hornhautödem nach unkomplizierter Kataraktoperation

“…3 [1]. Postoperative Descemet-Membran-Ablösungen treten am häufigsten nach Kataraktoperationen auf [9,11,12,15], sind aber auch nach Trabekulektomien [23], Iridektomien [9] und Pars-plana-Vitrektomien [10] beschrieben [1] [3,7,16,20]. Als ein wichtiges Anzeichen wird hier ein Stromaödem am ersten post-operativen Tag beschrieben [21,22].…”