Köppe Maximilian K, Khoramnia Ramin, Auffarth Gerd U, Augustin Victor A
University Eye Clinic Heidelberg, International Vision Correction Research Centre (IVCRC), Heidelberg, Germany.
GMS Ophthalmol Cases. 2024 Sep 23;14:Doc12. doi: 10.3205/oc000244. eCollection 2024.
Small Descemet membrane detachments after cataract surgery are relatively common and most cases do not require any secondary surgical intervention and can be treated conservatively. However, in case of advanced Descemet membrane detachment (DMD), it needs to be recognized and treated appropriately. The advent of anterior segment imaging using optical coherence tomography (OCT) technology has made diagnosing pathologies of the anterior segment accurate and time efficient and has proven as an invaluable tool to guide decision making.
A 71-year-old patient presented after complicated cataract surgery with decreased visual acuity and cloudy vision. On examination, best corrected visual acuity was 1.5 logMAR. A high-resolution swept-source OCT (Anterion, Heidelberg Engineering, Heidelberg, Germany) was used to better evaluate and visualize the extent of DMD. An anterior chamber gas bubble was injected to reattach the Descemet membrane (DM) to the corneal stroma. The success of the surgery was visualized using the high-resolution swept-source OCT. This revealed a completely attached Descemet membrane.
Clinically, it can be difficult to distinguish the etiology of epithelial and stromal edema post cataract surgery. This case demonstrated the clinical usefulness using high resolution swept source imaging to guide clinical decision making in evaluating timing and treatment success of pneumodescemetopexy after complicated cataract surgery.
白内障手术后小范围的后弹力层脱离相对常见，大多数病例无需二次手术干预，可进行保守治疗。然而，对于晚期后弹力层脱离（DMD），则需要正确识别并进行适当治疗。光学相干断层扫描（OCT）技术在前节成像中的应用，使前节病变的诊断准确且高效，已被证明是指导决策的宝贵工具。
一名71岁患者在复杂白内障手术后出现视力下降和视物模糊。检查时，最佳矫正视力为1.5 logMAR。使用高分辨率扫频源OCT（Anterion，德国海德堡工程公司，海德堡）更好地评估和显示DMD的范围。向前房注入气泡以使后弹力层（DM）重新附着于角膜基质。通过高分辨率扫频源OCT观察到手术成功，显示后弹力层完全附着。
临床上，白内障手术后上皮和基质水肿的病因可能难以区分。本病例展示了高分辨率扫频源成像在指导复杂白内障手术后评估气体后弹力层固定术的时机和治疗效果的临床决策中的作用。
