Detached Descemet’s membrane

Abstract

Introduction: Post operative complications following cataract surgery can present following a seemingly normal procedure, with few clues as to cause.

Case Description: A 62-year-old female had cataract surgery on her left eye. The surgery was uncomplicated until the end of the procedure. When the surgeon inserted a small cannula with balanced salt solution, to refill the anterior chamber just prior to checking the wound, the cornea gradually turned somewhat translucent. The following morning the cornea was cloudy and the visual acuity was count fingers.

The patient was referred and found to have visual acuity of count fingers without pain and normal intraocular pressure. An Ultrasound Biomicroscopic Examination (UBM) was performed, revealing a detached Descemet’s membrane, which could be seen in the anterior chamber waving within the aqueous. Five days later, reattachment of Descemet’s membrane was performed with air without complication. Within 4 weeks, the visual acuity was 6/12 with retinal pathology accounting for the remaining reduction in visual acuity.

Discussion: This patient was referred with a diagnosis of endothelial decompensation. The surgeon assumed that he had injected a toxic solution into the anterior chamber. The use of UBM allowed the diagnosis of Descemet’s detachment to be made in the setting of an opacified cornea. Repair with the use of air to re-approximate the membrane with its complement of endothelium led to visual recovery in four weeks.