Purpose
To assess the outcomes of repeat descemetopexy in post–cataract surgery Descemet membrane detachment.
Design
Retrospective interventional case series.
Methods
This multicenter, institutional study done between January 2007 and July 2013 included 13 eyes of 13 patients who underwent repeat descemetopexy after a failed initial procedure in post–cataract surgery Descemet membrane detachment. Patients without a minimum follow-up of 1 month were excluded. They underwent repeat descemetopexy with either 100% air or isoexpansile mixture of 14% C 3 F 8 . At 1 month, final status of Descemet membrane, final best-corrected visual acuity (BCVA), and incidence of postsurgical complications were noted.
Results
Mean age was 63.7 ± 6.6 years; male-to-female ratio, 8:5. Descemet membrane detachment involved the visual axis in all cases. Mean interval between 2 interventions was 5.1 ± 3.1 days. Same gas was used in 9 of 13 patients (air, 4; C 3 F 8 , 5). Air was used earlier and C 3 F 8 later in 4 patients. At 1 month, 12 of 13 patients had an attached Descemet membrane and improved mean logMAR BCVA ( P = .0036). One case developed postoperative pupillary block and 1 case required endothelial transplantation.
Conclusion
Repeat descemetopexy for post–cataract surgery Descemet membrane detachment gives good anatomic and visual results and is definitely a worthwhile attempt before a complex surgical procedure like keratoplasty is offered.
Descemet membrane detachment is a potentially vision-threatening complication of cataract surgery. Though reports of spontaneous resolution of Descemet membrane detachment exist in literature, it has been shown that medical treatment alone might not be sufficient in all cases and the mean time to resolution is also prolonged. Prolonged corneal edema may also lead to fibrosis, shrinkage, and wrinkling of the detached Descemet membrane, which might prevent reattachment and necessitate endothelial transplantation.
Descemetopexy, anterior chamber injection of gas to reposition the detached Descemet membrane, is now accepted as the standard of care for the management of post–cataract surgery Descemet membrane detachment. Potter and Zalatimo reported air to be the least effcacious tamponade as an agent for descemetopexy. The authors in their earlier publication have proved that air is more efficacious than C 3 F 8 without the risk of pupillary block. They reported 95% success in reattachment of Descemet membrane after descemetopexy with statistical improvement in visual acuity. Three patients in their series, however, had failure of outcome and they underwent subsequent endothelial transplantation.
Keratoplasty has its own inherent limitations, such as nonavailability of corneal tissue, requirement of a long follow-up, and risk of rejection and infection. Hence the authors considered whether attempting a repeat descemetopexy for persistent Descemet membrane detachment was worthwhile, a question that still remains unanswered in the current reported literature. We present a series of patients who underwent a repeat descemetopexy after a failed primary procedure for post–cataract surgery Descemet membrane detachment.
Patients and Methods
Study Design and Participants
This multicenter, institutional, retrospective, interventional case series was done at 2 centers as a continuation of earlier work done by the authors. It was approved by the institutional review board of L. V. Prasad Eye Institute, Hyderabad, India. As per the hospital protocol, a written informed consent was obtained from all patients before all surgical procedures and the investigations that they underwent.
This study included patients who developed Descemet membrane detachment after cataract surgery, underwent a descemetopexy procedure, and were then diagnosed to have persistent partial or complete Descemet membrane detachment and an overlying corneal stromal edema. The study duration was from January 1, 2007, to July 31, 2013. Descemet membrane detachment was described as earlier. Patients without a minimum follow-up of 1 month were excluded.
Data Collection
Demographic and clinical data of the patients included age, sex, severity of persistent Descemet membrane detachment, interval between the 2 descemetopexy procedures, and the preoperative best-corrected visual acuity (BCVA) in logMAR. As stated previously, the severity of the Descemet membrane detachment was classifed as mild if it involved <25% of the cornea and was peripheral, moderate if it involved 25%-50% of the cornea and was peripheral, and severe if it involved >50% of the cornea or involved the central cornea. These were given the score of 1-3 respectively. A special note was made of the type of gas used for descemetopexy in the initial and the repeat procedure ( Table ).
| Patient | Age (y) | Sex | Descemet Membrane Detachment Severity | Visual Axis Involved | Intervention (Air or C 3 F 8 ) | Interval Between 2 Interventions (days) | Best-Corrected Visual Acuity (logMAR) | Status of Descemet Membrane at 1 Month | Postoperative Complications | ||
|---|---|---|---|---|---|---|---|---|---|---|---|
| 1 st | Repeat | Preoperative | Postoperative | ||||||||
| 1 | 69 | F | 3 | Yes | C3F8 | C3F8 | 3 | 1 | 0.096 | Attached | – |
| 2 | 61 | M | 3 | Yes | Air | Air | 7 | 3 | 0.6 | Attached | – |
| 3 | 70 | M | 3 | Yes | Air | C3F8 | 1 | 0.3 | 0.096 | Attached | Pupillary block |
| 4 | 65 | M | 3 | Yes | Air | C3F8 | 1 | 1.69 | 0.39 | Attached | – |
| 5 | 75 | M | 3 | Yes | C3F8 | C3F8 | 3 | 3 | 0.3 | Attached | – |
| 6 | 60 | F | 3 | Yes | C3F8 | C3F8 | 8 | 0.39 | 0.22 | Attached | – |
| 7 | 62 | M | 3 | Yes | C3F8 | C3F8 | 11 | 3 | 2 | Detached | Failure |
| 8 | 69 | F | 3 | Yes | C3F8 | C3F8 | 8 | 2 | 0.7 | Attached | – |
| 9 | 50 | F | 2 | Yes | Air | Air | 8 | 0.18 | 0.18 | Attached | – |
| 10 | 56 | F | 3 | Yes | Air | C3F8 | 4 | 1 | 0.18 | Attached | – |
| 11 | 59 | F | 3 | Yes | Air | Air | 5 | 0.7 | 0.096 | Attached | – |
| 12 | 65 | M | 3 | Yes | Air | C3F8 | 6 | 2 | 0.22 | Attached | – |
| 13 | 67 | F | 2 | Yes | Air | Air | 2 | 0.7 | 0.18 | Attached | – |
| Mean | 63.7 | 2.84 | 5.15 | 1.46 | 0.4 | ||||||
| SD | 6.65 | 0.37 | 3.13 | 1.06 | 0.51 | ||||||
| Median | 65 | 3 | 5 | P = .0036 | |||||||
| 95% CI | 0.88-2.04 | 0.12-0.68 | |||||||||
Stay updated, free articles. Join our Telegram channel
Full access? Get Clinical Tree
