Manual schism and intracameral air injection for impacted Descemet’s membrane detachment

Abstract

A woman in her 60s was referred to us for management of poor vision following cataract surgery in the right eye. She had undergone manual small incision cataract surgery 12 weeks earlier. Slit-lamp biomicroscopy revealed corneal oedema, a horizontal line at the upper border and the adhered inferior border of detached Descemet’s membrane (DM). Clinical diagnosis of impacted Descemet’s membrane detachment (DMD) was considered.Surgical intervention with manual schisis and intracameral injection of air was planned. Using the ‘push technique,’ we tried to place the tip of the 27 gauge cannula between the back of the cornea and detached DM. The tip of the 27 gauge cannula was behind the impacted DM, and air injection was unsuccessful. Using the back-up the ‘pull technique,’ bent tip of the 27 gauge cannula was used to pull the impacted DMD. This manoeuvre, disimpacted the inferior border and the air bubble, was injected using the 27 gauge cannula. The air bubble unfolded and reattached the DM successfully.

A technique to treat Descemet’s membrane detachment following cataract surgery

“…Pneumodescemetopexy with intracameral injection of air or gases has become the preferred treatment for DMD. Due to the concerns of endothelial toxicity induced by gases ( 10 ), there is a trend toward using intracameral air alone in repairing DMD ( 9 ). In this report, we present a technique to manage DMD following cataract surgery.…”

“…Spontaneous resolution of corneal edema and reattachment of DMD in early and late cases has been reported. However, early surgical treatment is now advocated for cases with severe, scrolled, extensive, and visually impairing DMDs (1)(2)(3)(4)(5)(6)(7)(8)(9).…”