Delayed Descemet ’ s membrane detachment after successful cataract surgery : a case report

The detachment of Descemet’s membrane can be a serious complication following cataract surgery, leading to severe corneal edema and reduced visual acuity. This report describes an unusual case of Descemet’s membrane detachment 6 months after successful phacoemulsification, documented by anterior segment optic coherence tomography (OCT; RTVue, Optovue). The eye was treated successfully with pneumatic descemetopexy and transcorneal suturing, with reattachment of Descemet’s membrane. This report should alert physicians that delayed corneal edema can be related to late-onset Descemet’s membrane detachment, which requires proper treatment to avoid permanent corneal decompensation.


INTRODUCTION
T he detachment of Descemet's membrane can be a serious complication following cataract surgery, leading to severe corneal edema and reduced visual acuity. The exact pathogenesis of this complication remains unclear. This report describes an unusual case of Descemet's membrane detachment 6 months after successful phacoemulsification.

CASE REPORT
A 77-year-old female underwent uncomplicated phacoemulsification and single-piece hydrophobic intraocular lens (IOL) implantation (Acrysof ® SN60WF) in the right eye (OD). A 2.2 mm temporal clear corneal incision was performed without complications. After one week, her best corrected visual acuity (BCVA) was 20/20 OD with -0.50 sph. Six months later, she complained of a gradual, painless loss of visual acuity. Her BCVA was 20/40 OD and a slit lamp examination revealed localized corneal edema, extending from the side port incision to the central area ( Figure 1A). A fundus examination and intraocular pressure were within normal limits. The patient underwent anterior segment optic coherence tomography (OCT; RTVue, Optovue), which showed localized corneal thickening on the pachymetric map ( Figure 1B) and detachment of Descemet's membrane adjacent to the superior temporal corneal side port wound ( Figure 1C). The eye was treated successfully with pneumatic descemetopexy and transcorneal suturing with 10.0 nylon in the paracentesis, which was the site of the detachment, leading to the reattachment of Descemet's membrane. The cornea was clear at the 2-week follow-up, and the final BCVA was 20/20 OD (Figure 2).

DISCUSSION
Descemet's membrane detachment is common immediately after cataract surgery; however it is usually small, with minimal effect on visual acuity.
Some reports have suggested that Descemet's membrane detachment is related to an anatomic predisposition, such as endothelial abnormalities or surgical procedures, including instrument trauma. (1)(2)(3) There are a few reports of patients developing delayed Descemet's membrane detachment after phacoemulsification. (4)(5)(6) In our case, OCT was a useful adjunct diagnostic tool for diagnosing Descemet's membrane detachment and demonstrating the anatomic relationship between this complication and the clear corneal wound.
Although some authors have reported spontaneous resolution of Descemet's membrane detachment, (6,7) in our case, the intracameral injection of air and corneal suturing were successful at preventing fibrosis and resulted in the restoration of excellent visual acuity.
This report should alert physicians that delayed corneal edema can be related to late-onset Descemet's membrane detachment, which requires proper treatment to avoid permanent corneal decompensation.