Air descemetopexy may treat Descemet’s membrane detachment after cataract surgery

Issue: August 25, 2017

Air descemetopexy can treat Descemet’s membrane detachment after cataract surgery, avoiding the need for endothelial transplantation in many cases, according to a study.

At Aravind Eye Hospital in Pondicherry, India, air descemetopexy was performed in 112 patients between January 2013 and December 2015, out of 119,031 cataract surgery interventions. One hundred ten patients had at least 1 month of follow-up and were included in the analysis.

A 30-gauge hydrodissection cannula mounted on a 2 cc syringe was inserted through a small paracentesis to deliver air below the plane of the detached Descemet’s membrane. Patients were asked to maintain the supine position postoperatively to facilitate continuous tamponade.

The authors noted that a higher number of detachment cases occurred after extracapsular cataract extraction (0.26%) and manual small-incision cataract surgery (0.11%) as compared with phacoemulsification (0.04%) (P = .005 and P < .0001, respectively). The incidence was significantly higher among surgical trainees than expert surgeons (P .0001).

Descemet’s membrane was successfully attached in 78 eyes (71%). The 32 failures were correlated with large Descemet’s membrane tears or Descemet’s membrane loss leading to persistent corneal edema and decompensation in eight patients. Twenty-four patients had persistent detachment.

Of the 78 patients with reattached Descemet’s membrane at first intervention, 72 had visual acuity improvement of at least one line, and eight out of the nine patients who underwent a second descemetopexy also improved. At 1 month after successful descemetopexy, almost 75% of patients had vision better than 6/18.

According to the authors, air descemetopexy “should be tried even in patients with severe [Descemet’s membrane detachment] before planning a major surgery like endothelial keratoplasty that subjects the patient to long-term use of steroids and risks of graft rejection and graft failure.” – by Michela Cimberle

Disclosure: The authors report no relevant financial disclosures.

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Source:

Odayappan A, et al. Br J Ophthalmol. 2017;doi:10.1136/bjophthalmol-2016-309766.