ABSTRACT
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.
ABSTRACT
Background: Descemet’s membrane detachment (DMD) is an uncommon but serious complication of intraocular surgery. It requires prompt intervention to prevent corneal decompensation. Intracameral injection of air is the most commonly practiced and most successful modality of management in such circumstances. Aim and Objective: To analyze the possible causes of Descemet’s membrane detachment (DMD), evaluate the efficacy of intracameral air injection in its management, analyze when to do other interventions & to evaluate the outcome of patients after successful management. Methods: After Ethical committee approval, clinical data of 50 eyes of 50 patients during the period April 2014 to April 2016, who developed DM detachment after cataract surgery were noted. Study area: - IGIMS, Patna, Bihar, India. Study population: - 50 eyes of 50 post cataract surgery patients developing intra-operative DMD in the period of April 2014 to April 2016. Results: Patients were within the age group 54 to 82 years, mean was 65.38 ± 7.11. Sex distribution was 24 male and 26 female patients. Majority of the patients (n=37, 74%), had severe corneal edema. 8% had mild and 18% had moderate corneal edema. Descemet’s membrane detachment as noted from the ASOCT was, Range 10% to 95%, Mean 46.20, SD 24.065. Only air was sufficient to re-attach DMD ranged from 10% to 55%, mean = 36.50 and SD = 14.815. Visual acuity of patients on Post-Op (Day 1) versus Post-Op (1 week), c2 = 22.1 and P = 0.00019144, which was a significant improvement. Conclusion: Intra Cameral injection of air is demonstrated as a safe and efficacious option for the repair of Descemet's membrane detachment. Use of Isoexpansile 14% C3F8 is an effective and promising alternative for cases not resolving with repeated intra cameral air injection.