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Video Report

Detached Descemet's membrane

University of California, Davis Department of Ophthalmology & Vision Science, California

Correspondence: Dr Ivan R Schwab
Email: irschwab{at}ucdavis.edu Department of Ophthalmology & Vision Science, UC Davis Health System, 4860 Y Street, Suite 2400, Sacramento, CA 95817, USA

Date of acceptance: 7th June 2007

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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. The surgeon had inserted the lens into the capsular bag, and removed the viscoelastic from the anterior chamber. 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 surgeon checked the wound and found it be water tight, and applied a patch. The following morning the cornea was cloudy and the visual acuity was count fingers.

The patient was referred to our office and was found to have visual acuity of count fingers without pain and normal intraocular pressure. An Ultrasound Biomicroscopic Examination (UBM) was performed and is attached. A diagnosis of a detached Descemet's membrane was made. Five days later, reattachment of Descemet’s was performed with air without complication. Within four weeks, the visual acuity was 6/12 with retinal pathology accounting for the remaining reduction in visual acuity. A photograph of postoperative appearance at three weeks is shown in Figure 1.

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. Visualization of the anterior chamber was difficult, but the UBM confirmed the detachment of Descemet's membrane as can be seen from the video. Note Descemet's waving in the aqueous. Repair was straight forward with the use of air to re-approximate the membrane with its complement of endothelium. Visual recovery required approximately four weeks.

Figure 1 Slit lamp photograph showing the appearance 3 weeks after successful reattachment of Descemet’s membrane.