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.

Reverse graft suturing to avoid Descemet’s membrane detachment of glycerol-preserved donor cornea used for therapeutic penetrating keratoplasty during COVID-19 to overcome the tissue shortage – A novel surgical technique

To overcome tissue shortage during pandemic, we switched to 100% glycerol preservation of the donor cornea, which is economical and provides longer duration of storage than the short and intermediate storage mediums we normally use like McCAREY Kaufman (MK) or cornisol. During our initial few cases of therapeutic penetrating keratoplasty using glycerol preserved donor cornea, we faced spontaneous Descemet’s detachments resistant to air tamponade. We tried reverse graft suturing and successfully reinforced Descemet’s attachment along with air tamponade, in one of the cases after multiple failed air injections. In the subsequent two cases of infective keratitis needing therapeutic penetrating Keratoplasty, we took eight reverse sutures in between the eight cardinals, to anchor the Descemet’s membrane of the graft. Both the grafts showed attached Descemet’s and maintained good graft clarity. The reverse corneal suturing technique has not been described to the best of our knowledge and hope this helps our corneal fraternity.

​Corneal Complications After Manual Small-Incision Cataract Surgery – A Clinical Study In A Tertiary-Based Hospital

Aims and Objectives: The aim is to study the different corneal complications after manual small-incision cataract surgery(MSICS) and their implication on the final visual outcome in the patients.Design: It is a prospective, hospital-based observational study.Materials and Methods: The present study was done among 100 patients who underwent MSICS with implantation of posteriorchamber intraocular lens implantation. Study was conducted over a period of 3 months between March 2018 and May 2018 inGovernment Medical College, Jammu. All patients with clinically significant visual cataract admitted in Ophthalmology Departmentof Government Medical College, Jammu, during the study period were included. The post-operative corneal complications andbest corrected visual acuity (BCVA) of the enrolled patients were reviewed on the 1st, 7th, 15th, 30th, and 45th post-operative day.Results: 100 eyes of 100 patients consisting of 69 males and 31 females who underwent MSICS with intraocular lens implantationin the Department of Ophthalmology were studied. Majority of the patients belonged to the 60–69 years age group whichconstitutes 35 of the total patients. Out of 100 patients, 26 had corneal complications. 24 patients had striate keratopathy – outof whom 16 patients had mild grade striate keratopathy (<10 Descemet’s membrane folds [DMF]) and 8 patients had severegrade striate keratopathy (>10 DMF). 1 patient had microcystic corneal edema, and 1 patient had Descemet’s membranedetachment. After 6 weeks of post-cataract surgery, it was found that 89 patients achieved a BCVA of 6/9 or better.Conclusions: Corneal complications such as striate keratopathy are transient and resolve usually by the end of 2 weeks.Therefore, it was concluded that detailed pre-operative planning and careful surgery can prevent most of these complications.

Clinical observation of Descemet's membrane detachment after cataract surgery / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM: To investigate the causes and effective diagnosis and treatment of Descemet's membrane detachment in the patients received phacoemulsification combined with intraocular lens implantation and extracapsular cataract extraction combined with intraocular lens implantation. <p>METHODS: A retrospective analysis was applied for 2 069 eyes in 2006 patients which had received one of above-mentioned surgeries from January 2015 to December 2017. The treatment and prognosis of 26 patients(26 eyes)who had the complication of Descemet's membrane detachment during or after the surgery were observed. <p>RESULTS:After the appropriate treatment, no corneal endothelial decompensation happened in the 26 patients, and the visual acuity was improved to different extent. UBM confirmed that the Descemet's membrane was reset. <p>CONCLUSION: Early detection and appropriate treatment of Descemet's membrane detachment is important for the visual acuity recovery.

Analysis and treatment of explicit and occult Descemet's membrane detachment after phacoemulsification / 国际眼科杂志(Guoji Yanke Zazhi)

AIM: The reasons of explicit and occult Descemet's membrane detachment ( DMD ) after phacoemulsification were analyzed and the therapeutic measures were further provided. METHODS:A total of 31 cases diagnosed as explicit and occult DMD between Jan. 2013 and Apr. 2016 received the injection of sterile air into anterior chamber by 1-3 times, and were followed up for 3mo to observe the recoveries of cornea. RESULTS: A total of 30 cases recovered with no visual impairment and other related complications. One case which refused being treated resulted in bullous keratitis.CONCLUSION:Both the internal and external factors can influence the operation effect of explicit and occult DMD after phacoemulsification. Early detection and timely treatment play important roles in improving patients'visual acuity. Early examination of anterior segment OCT or UBM for intractable corneal edema is helpful to find the occult DMD with different degree and work out the targeted therapies.

Spontaneous Simultaneous Bilateral Late-onset Descemet’s Membrane Detachment after Uneventful Cataract Surgery.

We report the case of a 76-year-old woman who presented to us with bilateral simultaneous Descemet’s membrane detachment (DMD) after successful uneventful cataract surgery of both eyes in the late post-operative period. The first eye was operated 1-week prior to the second eye. We shall also discuss different hypothesis of an underlying predisposition to DMD and in our case the possible role of a thick arcus senilis in the etiology of DMD. Surgical intervention with 14% octafluoropropane (C3F8) gas injection in the anterior chamber resulted in excellent visual acuity restoration in the patient.

Analysis of causes and therapeutic measures on Descemet's membrane detachment during phacoemulsification / 国际眼科杂志(Guoji Yanke Zazhi)

AIM:To discuss the causes and therapeutic measures of Descemet's membrane detachment during phacoemulsification ( Phaco) . METHODS:A retrospective analysis of 997 patients who had operations of Phaco and intraocular lens ( IOL ) implantation at the eastern part of Yangzhou No. 1 People's Hospital during 2007-2012. The treatment and prognosis of 21 patients who had the complication of Descemet's membrane detachment during the surgery were observed. RESULTS: The vision acuity of all the 21 patients had improved to different extent after therapy, no one had the decompensation of corneal endothelium. CONCLUSION:Early detection and treatment is decisive for the vision acuity of the patients who had the Descemet's membrane detachment.

Bilateral Descemet's membrane detachment after uneventful phacoemulsification in a case of diabetes mellitus.

We report a diabetic patient with bilateral Descemet's membrane (DM) detachment after successive phacoemulsification. The DM detachments were diagnosed and documented in early postoperative period using anterior segment optical coherence tomography (OCT) and managed successfully by descemetopexy using 14% C3F8. This case highlights that some patients may be anatomically predisposed to DM detachment. Careful preoperative examination including specular microscopy should be done preoperatively especially in diabetic patients.

Double anterior chamber in a patient with glaucoma and microspherophakia.

We report the case of a 16-year-old woman with microspherophakia and secondary open angle glaucoma. The patient presented with a membrane dividing the anterior chamber into two segments without edema or Descemet's membrane detachment. Slit lamp biomicroscopy, Pentacam, and specular microscopy images were obtained. Double anterior chamber is primarily found in patients with anterior chamber anomalies when there is no history of surgery or trauma.

Role of anterior segment optical coherence tomogram in Descemet's membrane detachment.

Descemet's membrane detachment (DD) is a rare but serious complication of intraocular surgery. In rare cases where corneal edema is severe and we may not be able to visualize DD on slit-lamp examination, anterior segment optical coherence tomogram (AS-OCT) would be helpful. We describe two patients with DD, highlighting the role of AS-OCT in early diagnosis and management of patients with DD. One of the patients had DD with rolled in edge, which could only be visualized with AS-OCT. In such a situation, AS-OCT can identify the edge of detachment and show the exact position of the rolled edge, which can allow us to plan the surgical strategy to unroll the DD.

Three Cases of Descemet's Membrane Detachment after Cataract Surgery

Descemet's membrane detachment (DMD) is an uncommon condition with a wide range of etiologies. More than likely, the most common cause is a localized detachment occurring after cataract surgery. We report three cases of Descemet's membrane detachment that occurred after uncomplicated phacoemulsification cataract surgeries. The first patient was managed without surgical intervention, the second patient was treated using an intracameral air injection, and the last patient was treated with an intracameral perfluoropropane (C3F8) gas injection. All three patients recovered their vision following the reattachment of Descemet's membrane. The three patients were treated according to the extent of the detachment.

Descemet's Membrane Detachment Associated with Inadvertent Viscoelastic Injection in Viscocanalostomy

We report a case of Descemet's membrane detachment, a rare complication of viscocanalostomy. During the operation, the injection cannula was directed slightly oblique to the Schlemm's canal rather than parallel to it. Localized corneal whitening developed adjacent to the injection site during viscoelastic injection. One week postoperatively, corneal edema decreased and Descemet's membrane detachment was noted. Nine months after surgery, the cornea was clear while the Descemet's membrane detachment remained. And IOP was 19 mmHg without any medications. We think that improper cannula positioning during viscoelastic injection may cause Descemet's membrane detachment, a rare complication of viscocanalostomy.

Descemet's Membrane Detachment during 360 degreesTrabeculotomy

We report Descemet's membrane detachment during 360 degrees trabeculotomy using 6-0 polypropylene suture fragment. Using 6-0 polypropylene suture fragment 360 degrees trabeculotomy was performed on a 24-year-old male patient with juvenile glaucoma showing iris inserting anteriorly. Soon after pulling the suture fragment, anterior chamber became shallow abruptly and massive bleeding developed into anterior chamber. Corneal edema and large blood clot in anterior chamber were noted postoperatively.Rolled Descemet's membrane was attached to superior cornea.Seven and 14 days after trabeculotomy, viscoelastic was injected into anterior chamber and flattened the rolled Descemet's membrane.At 25 days after trabeculotomy, Descemet's membrane was reattached to central cornea, which became clear. Extensive Descemet's membrane detachment during 360 degrees trabeculotomy can be prevented by cautious pulling of suture fragments and injection of viscoelastic into anterior chamber just before pulling.When detached Descemet's membrane was rolled too tightly to be reattached by conventional procedure such as mattress suture or gas injection, the reattachment of the Descemet's membrane can be achieved by unrolling the membrane using viscoelastic