Descemet’s Membrane Detachment Following Corneal Suture Removal: Case Report

Abstract

Introduction: Descemet’s Membrane Detachment (DMD) is the separation of the descemet’s membrane from the overlying corneal stroma. It is a rare and a potential vision-threatening complication of cataract surgery, with incidence rates being reported at 0.044–0.5% after phacoemulsification and 2.5% after extra capsular extraction. In these cases, DMD is mostly seen during surgery or in the early post-operative period and it is associated to surgical technique, surgical equipment or genetic factors. It is one of the most serious complications of cataract surgery, leading to irreversible corneal decompensation. Small DMD may resolve spontaneously, but most large detachments require interventions such as pneumodescemetopexy. Case Report: We report a 70-year-old female patient, without any underlying disease, presented with the complaint of decreased vision in her pseudophakic right eye after a 15-weeks silent post-extra capsular cataract extraction period and two weeks after corneal suture removal. On slit-lamp examination, massive corneal edema was noticed on the temporal periphery with the involvement of the visual axis. Anterior segment optical coherence tomography revealed the presence of DMD in the superotemporal quadrant. To provide reattachment of DMD, we performed an anterior chamber tamponade with air. No complication associated with descemetopexy was noticed during recovery. Total Descemet’s membrane reattachment was achieved. Discussion: Among all intraocular surgeries, DMD is most commonly described after cataract surgery. It generally occurs in early- postoperative period and late-onset DMD have been reported less frequently. It presents as localized or diffuse corneal edema. Anterior segment optical coherence tomography examination can be clearly used for observation of the position and the range of DMD. There are several ways to manage DMD: medical treatment, pneumodescemetopexy, penetrating keratotplasty and endothelial keratoplasty. To the best of our knowledge, this is the first reported case of DMD after corneal suture removal. Conclusion: DMD after cataract surgery is associated with a variety of factors. Anterior segment optical coherence tomography examination can be used to find clear detachment of the descemet’s membrane. The position of detachment and surgical incision were found to be closely related. The location and the scope of detachment can be used to guide clinical treatments and improve prognosis of patients.