UNEXPECTED RESOLUTION OF DESCEMET’S MEMBRANE DETACHMENT AFTER CATARACT SURGERY

Descemet’s membrane detachment (DMD) is a complication that occurs most commonly after cataract surgery and can cause visual impairment. Most DMDs are small, peripheral to the site of corneal incisions, and resolve spontaneously after surgery. However, large and central DMDs cause corneal decompensation and opacification, leading to permanent visual acuity impairment. DMDs may be treated conservatively or surgically. Early intervention is preferred by many surgeons, particularly in large detachments. We report a case of a large and central Descemet’s membrane detachment post-cataract surgery that surprisingly resolved without surgical repair.

Case report of a patient submitted to phacoemulsification surgery at Ophthalmology Department of Unidade Local de Saúde de Matosinhos in Matosinhos, Portugal, in February 2024.

A 88-year-old man presented in an ophthalmology appointment complaining of diminished visual acuity in left eye (LE). Past medical history included prostate cancer. His best-corrected visual acuity (BCVA) in the right eye was 20/25 and in the LE 20/100. Intraocular pressure was normal and slit-lamp biomicroscopy revealed a corticonuclear cataract in the LE. Fundus examination showed macular pigmentary changes. The patient underwent an uneventful phacoemulsification cataract surgery and was treated with topical antibiotic, corticosteroid and anti-inflammatory. On postoperative day 1, a generalized corneal edema was noted; we intensified dexamethasone to 6 times daily and added 5% hypertonic saline drops 4 times daily. On postoperative week 1, week 2 and month 1, corneal edema was persistent, and BCVA remained counting fingers. Prednisolone + chloramphenicol ointment was added, maintaining the remaining treatment. On month 2 evaluation, bullous keratopathy and central cornea edema was observed, and anterior segment optical coherence tomography (AS-OCT) was performed. A central Descemet’s membrane detachment was detected. Considering the patient’s age and comorbidities, a conservative approach was chosen, involving long-term treatment with hypertonic solutions and corticosteroids on a tapering regimen, along with regular follow-up appointments. A slow and gradual improvement in visual acuity was observed, and on month 3, BCVA was 20/40. On month 4, BCVA was 20/32 and AS-OCT showed reattachment of Descemet’s membrane. On month 5, BCVA was 20/25, and persistent faint folds in Descemet’s membrane were observed. Specular microscopy showed diminished cell count, polymegathism, normal corneal thickness and no guttata, and the patient was satisfied with his final vision.

The prognosis of DMD depends not only on the size and position of the DMD but also on the degree of endothelial damage and the function of the remaining cells. Even in a large DMD with visual axis involvement, conservative treatment with close follow-up might still provide a satisfactory outcome.