Bhatia Harsimran Kaur, Gupta Rakesh
Shreya Eye Centre, D-163, Surajmal Vihar, Delhi, India.
BMC Ophthalmol. 2016 Apr 4;16:35. doi: 10.1186/s12886-016-0212-6.
Descemet membrane detachment (DMD) is a significant complication noted during or early after cataract surgery. Review of literature revealed a few cases of delayed-onset DMD with presentation ranging from weeks to months after cataract surgery but most of them were treated with pneumatic descemetopexy and a few ended in penetrating keratoplasty. We report this case, to highlight the usefulness of corneal venting incision with air tamponade in late-onset DMD cases not responding to pneumatic descemetopexy.
A retrospective case review of a 66 year old male who presented with diminution of vision in right eye 17 days after uneventful cataract surgery was done. Visual acuity in this eye was 20/200 at presentation. DMD was noted 3 days later (approximately 3 weeks post-operatively) and Anterior Segment Optical Coherence Tomography & Scheimpflug imaging were done in view of diffuse corneal edema. Pneumatic descemetopexy was attempted thrice (twice with SF6, once with air) over a week's span with limited success at re-attaching the DM. Finally, corneal venting incision with air tamponade was done resulting in egress of supra-descemet's fluid and DM appeared apposed to stroma. Bandage contact lens (BCL) was applied at the end of the procedure. DM was seen attached the next day. Corneal edema cleared completely in 1 week. Best corrected visual acuity (BCVA) at 6 weeks follow-up was 20/30.
Delayed-onset DMD should be considered as a differential diagnosis in cases with late-onset corneal edema post-cataract surgery. Anterior segment Optical Coherence Tomography (AS-OCT) and Scheimpflug Imaging are useful tools in cases with dense corneal edema. Corneal venting incision with air tamponade is an option in cases where methods like pneumatic descemetopexy fail.
后弹力层脱离（DMD）是白内障手术期间或术后早期出现的一种严重并发症。文献回顾显示，有少数迟发性DMD病例，其表现为白内障手术后数周数月不等，但大多数经气体后弹力层固定术治疗，少数最终行穿透性角膜移植术。我们报告此病例，以强调在对气体后弹力层固定术无反应的迟发性DMD病例中，角膜排气切口联合空气填塞的有效性。
对一名66岁男性进行回顾性病例分析，该患者在白内障手术顺利完成17天后出现右眼视力下降。就诊时该眼视力为20/200。3天后（术后约3周）发现DMD，鉴于角膜弥漫性水肿，进行了眼前段光学相干断层扫描和眼前节全景成像检查。在一周内尝试了三次气体后弹力层固定术（两次使用六氟化硫，一次使用空气），在重新附着后弹力层方面效果有限。最后，进行了角膜排气切口联合空气填塞，导致后弹力层上液体积聚排出，后弹力层似乎与基质贴合。手术结束时佩戴了绷带式隐形眼镜（BCL）。第二天可见后弹力层已附着。角膜水肿在1周内完全消退。6周随访时最佳矫正视力（BCVA）为20/30。
迟发性DMD应被视为白内障手术后迟发性角膜水肿病例的鉴别诊断之一。眼前段光学相干断层扫描（AS-OCT）和眼前节全景成像在角膜严重水肿的病例中是有用的工具。在气体后弹力层固定术等方法失败的情况下，角膜排气切口联合空气填塞是一种选择。
