Descemet membrane tear after cataract surgery

Descemet membrane detachment is a potentially devastating complication of cataract surgery. Small localized detachments are rarely problematic, however persistent extensive detachments can affect visual acuity. In severe cases penetrating keratoplasty may be required for restoration of vision. One case of a persistent descemets membrane tear is presented and the progress after surgical repair via suture and injection of air is described. The patient was followed for 5 months after repair with persistent haze and mild corneal edema, though vision improved to 20/25+.     

Descemet membrane tear after cataract surgery

Descemet membrane detachment is a potentially devastating complication of cataract surgery. Small localized detachments are rarely problematic, however persistent extensive detachments can affect visual acuity. In severe cases penetrating keratoplasty may be required for restoration of vision. One case of a persistent descemets membrane tear is presented and the progress after surgical repair via suture and injection of air is described. The patient was followed for 5 months after repair with persistent haze and mild corneal edema, though vision improved to 20/25+.     

Descemet membrane detachment after nonpenetrating filtering surgery

PURPOSE: To make surgeons performing nonpenetrating filtering surgery aware of an unusual complication namely Descemet membrane detachment. METHODS: We retrospectively reviewed nine eyes of nine patients seen in our hospital with Descemet membrane detachment occurring after nonpenetrating filtering surgery from January 1994 to December 2000. RESULTS: Both planar and nonplanar detachments were reported. Neither scrolls nor tears in the Descemet membrane were observed in any patient. After viscocanalostomy (four patients), the detachment was generally noticed shortly after the procedure and the cornea maintained its clarity. After deep sclerectomy with a collagen implant (five patients), it developed weeks to months postoperatively with adjacent corneal edema. Four patients had descemetopexy. None required more than one procedure. However, at the last visit, two detachments persisted although they had diminished in size: one after viscocanalostomy and conservative treatment and one after descemetopexy after deep sclerectomy with a collagen implant. To date otherwise, no signs of significant corneal damage could be observed clinically nor by specular microscopy and pachymetry. CONCLUSIONS: The diagnosis of Descemet membrane detachment can be easily overlooked or misdiagnosed. The clinical presentation, clinical course, and pathogenesis depend on the type of nonpenetrating filtering surgery performed. Ophthalmologists should be aware of this unusual complication, which is likely to be more common after nonpenetrating filtering surgery than after trabeculectomy. A period of observation before attempting descemetopexy is recommended.     

Descemet membrane detachment after trabeculectomy

Descemet’s membrane detachment (DMD) can be a potentially serious complication of intraocular surgery or ocular trauma. The cause is not very clear. We are trying to remind an awareness of the spectrum of DMD resulting from trabeculectomy by presenting a case of extensive DMD after trabeculectomy which was successfully repaired.     

Descemet membrane detachment after viscocanalostomy

PURPOSE: To report a case that developed a large Descemet membrane detachment after viscocanalostomy. METHODS: Case report. A 60-year-old man with primary open-angle glaucoma underwent viscocanalostomy RE. One day after surgery, a small, localized detachment of Descemet membrane was present at the operation site. Six months after surgery, he had a large superior Descemet membrane detachment involving his visual axis. RESULTS: The Descemet membrane remained attached after descemetopexy with sodium hyaluronate and air. Final visual acuity was 20/80, and intraocular pressure was 17 mm Hg without medication. CONCLUSION: Detachment of the Descemet membrane should be recognized as a potential complication of viscocanalostomy.     

白内障术中大范围后弹力层脱离的临床观察

目的 分析白内障行超声乳化联合人工晶状体植入术致角膜后弹力层大范围脱离的原因及处理方法.方法 825例（856眼）超声乳化人工晶状体植入术,术中大范围后弹力层脱离6例（7眼）,进行了保守治疗、手术缝合及前房注入C3F8.结果 植入人工晶状体前发现大范围后弹力层脱离的5眼行手术缝合,术后前房注入C3F8;植入人工晶状体后发现大范围后弹力层脱离的1眼前房注入C3F8;另1眼术中后弹力层不慎吸出,进行保守治疗.结论 正确及时的综合治疗是晶状体超声乳化人工晶状体植入术中角膜后弹力层大范围脱离有效的治疗方法.     

Repair of Descemet's membrane detachment after cataract surgery

PURPOSE/METHODS: We present two cases of Descemet's membrane detachment, the first one after extracapsular cataract extraction with scleral tunnel incision and the other after clear corneal incision used for phacoemulsification cataract extraction. These two cases were treated with intracameral injection of 20% sulfur hexafluoride gas (SF(6)). RESULTS/CONCLUSIONS: Both cases responded satisfactorily to treatment. After four months of follow-up, the corneas remain clear with a visual acuity of 0.9 and 0.8, respectively. The relative facility of the 20% sulfur hexafluoride gas (SF(6)) technique, its safety, and good prognosis, makes it the treatment of choice in this disease.     

Consecutive Descemet membrane detachment after successive phacoemulsification

PURPOSE: To report a patient with consecutive Descemet's membrane (DM) detachments after successive phacoemulsification, review other reported patients with bilateral DM detachments, and explore the possibility of anatomic predisposition to DM detachment in some patients. METHODS: Our patient's course was reviewed along with the reported experience with three other patients with bilateral DM detachments. RESULTS: No clear underlying etiology of DM detachment was found in our patient or any of the other three reported patients reviewed. CONCLUSIONS: Some patients may be anatomically predisposed to DM detachment possibly because of an abnormality in the fibrillary stromal attachment to DM. Early postoperative surgical intervention often leads to satisfactory visual results.     

白内障术后角膜后弹力层脱离的临床观察

目的：探讨白内障超声乳化联合人工晶状体植入术及白内障囊外摘除联合人工晶状体植入术所致角膜后弹力层脱离的原因及有效诊疗方法。

方法：回顾性分析2015-01/2017-12在我院行白内障超声乳化联合人工晶状体植入术或白内障囊外摘除联合人工晶状体植入术的2 006例2 069眼,对术中或者术后发生角膜后弹力层脱离的26例26眼患者的诊疗及预后进行临床观察。

结果：发生不同程度角膜后弹力层脱离的26例26眼患者经相应治疗,未发生角膜内皮失代偿。角膜水肿消退,恢复透明,视力不同程度地提升。UBM检查证实后弹力层复位。

结论：白内障术中术后及时发现,根据不同情况选择合适的治疗方法,是治疗白内障术后角膜后弹力层脱离,恢复患者视力的关键。     

Descemet's membrane detachment after cataract surgery: management and outcome

OBJECTIVE: To analyze the possible causes of Descemet's membrane detachment (DMD) and the treatment and outcome of patients after cataract surgery. DESIGN: Retrospective noncomparative interventional case series. PARTICIPANTS: Fifteen eyes of 12 patients. METHODS: We reviewed clinical data on 15 eyes of 12 patients with nonscrolled DMD after cataract surgery who presented to the Cornea Service at Wills Eye Hospital from 1986 to 2001. Institutional review board/ethics committee approval was obtained. MAIN OUTCOME MEASURES: Visual acuity and reattachment of Descemet's membrane. RESULTS: Cataract procedures involved nine clear-corneal eyes, four limbal incisions, one trabeculectomy/combined phacoemulsification, and one extracapsular cataract extraction. From 1986 to 1990, we had 1 patient; from 1991 to 1995, no patients; and from 1996 to 2001, 11 patients (including all clear-corneal eyes). Of the 15 eyes, 8 resolved with medical treatment alone, with a mean time to resolution of 9.8 weeks. One patient was lost to follow-up while improving on medical treatment, and another required a penetrating keratoplasty (PK) after medical treatment failed. Five eyes received anterior-chamber SF(6) gas injection. Of these eyes, three DMDs resolved, one underwent repeated injection (not improving after 10 weeks), and another required a PK. CONCLUSIONS: Referrals for DMD seem to be increasing. This may be explained by the increase in clear-corneal cataract procedures. Medical treatment seems to be adequate in many cases and may be appropriate initial therapy. When needed, SF(6) gas injection may also be successful, but not in all cases.     

Retinal detachment after cataract surgery

Background: A study of the characteristics and the results obtained in 99 consecutive eyes operated on for rhegmatogenous retinal detachment associated with aphakia or pseudophakia in order to find the predictive factors of poor anatomical and functional results. Methods: The authors retrospectively reviewed the files of 99 consecutive cases of aphakic and pseudophakic retinal detachment operated on by the same surgeon between January 1992 through July 1993 with a minimum follow-up of 6 months. Multivariate and chi square analysis were carried out. Results: Of the pseudophakic eyes, 25 had an anterior chamber lens and 48 had a posterior chamber lens. The posterior capsule was disrupted using a Yag laser in 58% of those with an posterior chamber lens but only 14% of them developed detachment within 6 months. The rate of vitreous loss was 27% with 5% in case of intracapsular extraction, 31% in case of extracapsular extraction and 54% in case of phacoemulsification. PVR was present in 30% of the patients and 51% of detachments occurred more than 24 months as a mean after cataract surgery. The overall anatomic reattachment rate was 88% with no significant difference between the aphakic and the pseudophakic patients, either with an anterior chamber of posterior chamber lens. Visual results were significantly worse in the anterior chamber lens group and in the aphakic eyes (P < 0.02). Negative prognostic indicators for reattachment included poor preoperative vision, extension of the retinal detachment to the macula (P < 0.05) and grades B, C or D proliferative vitreoretinopathy (P < 0.01). In addition to the above factors, eyes with vitreous loss, anterior chamber lens, aphakia and a larger extent of the retinal detachment had a poor visual outcome. Conclusion: Most aphakic or pseudophakic retinal detachment can now be reattached with either scleral or vitreo retinal surgery. The main difficulties are the localisation of the breaks and the treatment of PVR. Indirect ophthalmoscopy associated with vitrectomy does well in cases of an opacified posterior capsule. In cases of severe PVR long term internal tamponade either with C3F8 or silicone oil improves anatomical results but the functional results remain inferior.     

Postoperative Descemet membrane detachment with maintenance of corneal clarity after trabeculectomy

This case report describes an unusual complication of Descemet membrane detachment after anterior chamber reformation to treat a flat anterior chamber and hypotony from a trabeculectomy. This large Descemet membrane detachment was unexpectedly associated with a clear cornea. Treatment was conservative, and the Descemet membrane detachment spontaneously resolved in 6 months.