With great interest I read the article by Jain and associates on the outcomes of repeated descemetopexy in post-cataract surgery Descemet membrane detachment. Persistent Descemet membrane detachment after intraocular surgery leads to corneal edema, which compromises vision if the visual axis is involved. This study reported a promising effect of repeated descemetopexy at 1 month in 12 of 13 patients. The only one who failed had taut Descemet membrane detachment.

It indeed was interesting that the methods of the first and repeated descemetopexy were the same. The mean interval between 2 interventions was 5.1 ± 3.1 days. How to explain that the Descemet membrane could not be attached the first time but was attached successfully with a repeated procedure not too long later? Was the Descemet membrane attached completely and shortly in all of the 12 patients after repeated descemetopexy? The only difference between 2 interventions was the gas for intracameral injection in 4 cases, who received room air initially and 14% isoexpansile perfluoropropane (C ₃ F ₈ ) in the repeated procedure. Given comparable reattachment rates with air and C ₃ F ₈ , using different agents may not be able to explain it.

What was the average time period between the cataract surgery and the first descemetopexy? Delay in repair may be complicated by inflammation related shrinkage, wrinkling or fibrosis of the Descemet membrane. The authors stated that optical coherence tomography (OCT) had been performed whenever required. What were the initial findings of OCT in the 12 patients who successfully achieved good anatomic and visual outcomes after repeated descemetopexy? Did they have a special configuration of Descemet membrane detachment? For example, patients with curling or folding of the Descemet membrane may need repeated interventions. Descemet membrane detachment may reoccur in patients who have intrinsically compromised endothelium, and multiple interventions are needed. How was the endothelial function in the 12 patients?

If we could figure out why the first operation failed in some patients, then we would handle the patients with Descemet membrane detachment more efficiently in the future. Despite the inherent limitations of a retrospective study, this study provides more information about management of Descemet membrane detachment and opens up further studies in a large series.