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

Harsimran Kaur Bhatia,Rakesh Gupta

doi:10.1186/s12886-016-0212-6

Abstract

BackgroundDescemet 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 presentationA 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.ConclusionDelayed-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.

Highlights

Descemet membrane detachment (DMD) is a significant complication noted during or early after cataract surgery
Delayed-onset DMD should be considered as a differential diagnosis in cases with late-onset corneal edema post-cataract surgery
Corneal venting incision with air tamponade is an option in cases where methods like pneumatic descemetopexy fail

Summary

Conclusion

This discussion is meant to highlight the delayed-onset DMD which should be considered as a differential diagnosis in cases with late-onset corneal edema postcataract surgery. An AS-OCT or a Scheimpflug imaging is warranted in post-operative cases with dense corneal edema to pick up any DMD and differentiate it from cases of pseudophakic or aphakic bullous keratopathy (PBK/ABK). More studies with larger sample sizes need to be done to explain the mechanism of delayed-onset DMD and diagnose the cases at risk before contemplating surgery. Authors’ contributions HKB conceptualized and designed the work, acquired the data and drafted the manuscript. RG conceived the study, supported the work at every step and critically revised the manuscript. Both authors read and approved the final manuscript

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