Management Of Descemet Membrane Detachment Research Articles

Double bubble pneumo-descemetopexy for the management of Descemet membrane detachment: An innovative technique.

A 62-year-old woman was referred with poor vision following manual small incision cataract surgery. On presentation, the uncorrected distance visual acuity in the involved eye was 3/60, whereas slit-lamp examination revealed a central corneal edema with the peripheral cornea relatively clear. Direct focal examination with a narrow slit upper border and lower margin of detached rolled up Descemet's membrane (DM) could be visualized. We performed a novel surgical approach, "double-bubble pneumo-descemetopexy." The surgical procedure included unrolling of DM with "small air bubble" and descemetopexy with "big bubble." No postoperative complications were observed, and best corrected distance visual acuity improved to 6/9 at 6 weeks. The patient had a clear cornea and maintained BCVA 6/9 during 18 months at follow-up. Double-bubble pneumo-descemetopexy, a more controlled technique, provides a satisfactory anatomical and visual outcome in DMD without the need for endothelial keratoplasty (Descemet's stripping endothelial keratoplasty or DMEK) or penetrating keratoplasty.

Diagnosing Descemet Membrane Detachment in Patients Undergoing Cataract Surgery using an AS-OCT-based HELP Algorithm: A Prospective Cross-sectional Study

Introduction: Descemet Membrane Detachment (DMD) is a rare complication of cataract surgery which is more likely to occur during the learning curve especially during surgical training in residency. There are various methods of diagnosing DMD using slit lamp biomicroscopy, Ultrabiomicroscopy (UBM) and Anterior Segment Optical Coherence Tomography (AS-OCT). AS-OCT can be utilised to confirm, classify DMD and decide the plan of management by using Height, Length, Extent and Pupil (HELP) algorithm. Descemetopexy is the gold standard treatment in the management of DMD. The management of DMDs usually depends upon the site and extent of the detachment. Prompt diagnosis and timely management, leads to a good functional and anatomical outcome. Aim: To study the occurrence and management of DMDs during cataract surgeries using an AS-OCT-based HELP algorithm in a training hospital. Materials and Methods: This prospective cross-sectional study, included 25 eyes of 25 patients, who underwent cataract surgery which resulted in DMD in Bharati Vidyapeeth (Deemed to be University) Medical College and Hospital, Sangli, Maharashtra, India, from June 2021 to December 2021. AS-OCT-based HELP algorithm was used for diagnosis and determining, whether medical management needs to be done or surgical management. Either medical or surgical management (Descemetopexy) was done in all the 25 eyes. All the study subjects were followed on Postoperative Day (POD)- 1,7,30 for Descemet’s Membrane (DM) reattachment. The outcome measures were successful DM reattachment and/or improvement in visual acuity by atleast two Snellen lines. Paired t-test was used to test the mean difference between LogMAR visual acuity values pre and postoperatively. The p-value <0.05 was considered as statistically significant. Results: Out of 1008 cataract surgeries, 25 patients had DMD intraoperatively. The mean age of the patients was 61.12±7.29 years with a male:female ratio of 10:15. The most common surgery preceding DMD was Manual Small Incision Cataract Surgery (MSICS) (84%; n=21). The mean pre- and postmanagement visual acuities were 0.96±0.445 and 0.215±0.196, respectively (p<0.0001). A successful DM reattachment was seen in 92% (n=23) with the first attempt. There was a statistically significant improvement in visual acuity after management (p<0.0001). Conclusion: Management of DMD is crucial, as early diagnosis and treatment of patients with DMD leads to good visual outcome. AS-OCT-based HELP algorithm is very beneficial in the diagnosis of DMD. Descemetopexy is the gold standard in the management of DMD.

An alternative technique for persistent Descemet's membrane detachment following phacoemulsification

Descemet's membrane detachment (DMD) is an uncommon complication of cataract surgery. The prognosis depends upon the prompt recognition and management of DMD. The use of various modalities such as AS OCT, Schiemflug imaging and pachymetry helps in proper diagnosis and selecting appropriate management options. Majority of the DMD are small and spontaneously resolve on their own. For small and limited DMD, Medical management with observation are suffice. For persistent large DMD, descemetopexy with the use of expansile gases have been used to tamponade the DM. Use of HELP algorithm has led to objective assessment of DMD and thinning the grey line between either going for observation or intervention with various modalities available. If descemetopexy fails, corneal venting incision can be used as a last resort before going for Keratoplasty. Keratoplasty still remain the treatment of choice for long standing and persistent DMD.

Management of Descemet membrane detachment secondary to forceps assisted delivery in a newborn

To describe the clinical signs and management of Descemet membrane (DM) detachment after forceps-related trauma during birth. A 2-day-old term infant presented with right eye corneal clouding and history of forceps assisted delivery. Ophthalmic assessment was consistent for corneal trauma and anterior segment optical coherence tomography (AS-OCT Visante®) revealed DM detachment. Prolonged topical treatment considerably reduced edema, but after four months of treatment superior DM detachment persisted, anterior chamber air injection at this point also failed to achieve apposition. Central visual axis remained partially spared in the months to follow, and intensive amblyopia treatment was indicated. Prolonged topical treatment may be helpful to reduce edema and risk of severe amblyopia in DM tears secondary to forceps traumatism at birth, but insufficient in cases of large DM detachment.

Anterior Segment Optical Coherence Tomography-Guided Management Algorithm for Descemet Membrane Detachment After Intraocular Surgery.

To evaluate the role of anterior segment optical coherence tomography (ASOCT) in the detection and management of Descemet membrane detachment (DMD) in cases of persistent corneal edema after intraocular surgery. An ASOCT-guided new algorithm for the management of such DMDs is described. Thirty-seven consecutive cases of persistent corneal edema of more than 2-week duration after intraocular surgery were included. All cases referred had no response to medical therapy. ASOCT was performed in all eyes. DMDs that were in the superior half of the cornea with a planar configuration alone were managed using intracameral air, and those with scrolled edges were managed using intracameral 14% perfluoropropane (C3F8). DMDs that were in the inferior half of the cornea with planar or scrolled edges were managed using intracameral C3F8 injection. The parameters evaluated were the type and morphology of DMD, resolution of DMD, and best-corrected visual acuity. Using ASOCT, DMD was found to be present in 25 eyes. All cases had planar edges, and 52% (13/25) cases had scrolled edges. In 48% (12/25) cases, DMD was peripheral. Descemetopexy with intracameral air or 14% C3F8 gas showed resolution in all cases with the mean time to resolution being 16.0 ± 7.1 days. ASOCT is a useful tool for timely diagnosis, characterization, and management of DMD in cases of nonresolving postoperative corneal edema. A new algorithm for intracameral injection of air or C3F8 in these cases helps to defer corneal transplantation.

Height-, extent-, length-, and pupil-based (HELP) algorithm to manage post-phacoemulsification Descemet membrane detachment

To analyze the functional and anatomic outcomes of management of Descemet membrane detachment after phacoemulsification using a protocol based on the detachment's height, extent, and chord length and its relation to the pupil. Dr. Agarwal's Eye Hospital and Eye Research Centre, Chennai, India. Prospective comparative case series. Eyes with post-phacoemulsification Descemet membrane detachment were managed surgically or medically based on the detachment's height, extent, length (chord), and relation to the pupil (HELP protocol). Central corneal thickness (CCT), chord length, and detachment height were determined by anterior segment optical coherence tomography (AS-OCT) (Visante). Of 161 eyes, 96 were treated surgically (Group 1) and 65 medically (Group 2). The mean length and mean height of Descemet membrane detachment were 2.4 mm ± 1.4 (SD) and 266 ± 189.8 μm, respectively, in Group 1 and 1.03 ± 0.4 mm and 153.3 ± 60.8 μm, respectively, in Group 2. The complete reattachment rate was 95.8% in Group 1 and 96.9% in Group 2. The corrected distance visual acuity (CDVA) was 20/40 or better in 83.3% of eyes in Group 1 and 92.3% of eyes in Group 2. No eye lost CDVA as a result of a Descemet membrane scar in the central 5.0 mm of the cornea. The AS-OCT allowed visualization of the detachment in all eyes with a CCT of more than 800 μm. There was no difference in the final CDVA between Group 1 and Group2. The AS-OCT-based algorithm was effective for managing post-surgical Descemet membrane detachment in eyes with dense corneal edema. Early surgical intervention for detachments in the central cornea can reduce scarring-induced visual loss. No author has a financial or proprietary interest in any material or method mentioned.

Descemet Membrane Detachment After Canaloplasty

To report the incidence and management of Descemet membrane detachment (DMD) after canaloplasty. Review of all patients who developed DMD after canaloplasty at Tulane Glaucoma Services was performed. Visual acuity, intraocular pressure, and number of glaucoma medications up to 1 year of follow-up were included in the analysis. The incidence of DMD was 7.4% (12 eyes of 162). Eighty-three percent (10/12) of the DMDs involved the inferior quadrants and measured <3 mm. Intracorneal hemorrhage within DMD occurred in 58% (7/12), whereas 42% (5/12) developed DMD with intracorneal viscoelastic (Healon GV) alone. Two patients had large detachments measuring 5 to 6 mm extending into the visual axis. DMD resolved completely with or without drainage except for 1 patient who developed corneal decompensation, needing penetrating keratoplasty. DMD with or without intracorneal hemorrhage is not an infrequent complication of canaloplasty and can occasionally lead to corneal decompensation.

Update on diagnosis and management of Descemetʼs membrane detachment

Descemet's membrane detachment (DMD) is commonly encountered after intraocular surgery and ocular trauma. Although its occurrence has been known for a long time, the disease course and its optimal management is not yet fully understood. This review aims to present an update on current trends in diagnosis and management of DMD. Different causes as well as a variable course of disease exist for DMD. Although some DMDs reattach spontaneously with a good visual outcome, some corneas clear without the need for an attached membrane and a few corneas do not clear in spite of an attached Descemet's membrane. DMDs may be treated either conservatively or surgically, with many surgeons favouring an early surgical intervention especially for scrolled, extensive and sight-disabling DMDs. However, due to an unknown course of the disease, exact timing and nature of surgical intervention could not yet been fully defined. Most DMDs can now be recognized and managed successfully with good visual outcome. However, optimal timing and treatment strategy for different DMDs remain an area to be explored for the best visual recovery for patients.

The benefit of ultrasound biomicroscopy (UBM) in management of total Descemet’s membrane detachment after deep sclerectomy surgery

The purpose of this study is to report the importance of ultrasound biomicroscopy (UBM) in the diagnosis of Descemet's membrane detachment (DMD) and the efficacy of sulfur hexafluoride (SF6) gas in its management. DMD was identified by UBM in a 22-year-old woman with juvenile glaucoma who underwent deep sclerectomy surgery and developed severe corneal oedema postoperatively. SF6 gas 15% was injected into the anterior chamber. The procedure resulted in reattachment of Descemet's membrane and a completely clear cornea. DMD can be easily overlooked or misdiagnosed after non-penetrating glaucoma surgery. UBM is helpful in diagnosis and management of DMD and descemetopexy with SF6 gas can give good results.

Role of anterior segment optical coherence tomography in the management of descemet membrane detachment

Role of anterior segment optical coherence tomography in the management of descemet membrane detachment