A CASE REPORT OF SPONTANEOUSLY RESOLVING DESCEMET’S DETACHMENT AFTER CATARACT SURGERY.

To present a case of spontaneous resolution of a large central Descemet's membrane detachment (DMD) following cataract extraction surgery, and to discuss potential management strategies.

A tertiary care center in Lebanon, a developing country.

A 79-year-old man underwent a cataract extraction surgery complicated by posterior capsular rupture that required anterior vitrectomy. Initial post operative exam revealed 3+ descemet folds and corneal edema that was treated with prednisolone acetate 1% drops administered hourly and hypertonic sodium chloride drops (NaCl 3%) 1 drop applied 4 times daily. At post-operative day 9, Anterior segment optical coherence tomography (AS-OCT) revealed a central DMD. Observation and close follow up were recommended. The patient was maintained on the same treatment. A repeat AS-OCT at week 4 revealed no change in the DMD, accompanied by persistent corneal edema and unimproved vision. Specular biomicroscopy indicated an average endothelial cell count of 924 in the left eye, while the right eye showed no measurable signal. A Descematopexy procedure with sulfur hexafluoride was planned to enhance recovery but was postponed due to the patient's loss to follow-up. By week 6, the patient’s uncorrected visual acuity (UCVA) improved to 20/30, and the best-corrected visual acuity (BCVA) was 20/20. AS-OCT confirmed the spontaneous resolution of the Descemet membrane detachment (DMD), showing a clear cornea with a central corneal thickness (CCT) of 474 µm. Specular microscopy revealed a cell density of 1021 cells/mm³ in the right eye.

This case brings to light important clinical considerations in managing DMD after cataract surgery. While DMD is a known complication, this case shows that even large, central detachments can sometimes resolve on their own without the need for surgery. As a result, conservative approaches—such as careful observation and medical treatment—may be sufficient in certain situations, offering an alternative to more invasive procedures. Nevertheless, the decision between surgical intervention and watchful waiting should always be tailored to each individual patient, taking into account the specific details of their detachment, their overall eye health, and their ability to attend follow-up appointments.