Descemet membrane detachment during foldable intraocular lens implantation

Descemet membrane detachment (DMD) during phacoemulsification is a well-known complication. Although most of the DMDs resolve on their own, some may require surgical intervention in the form of intracameral injection of air or isoexpansive gas. We report the occurrence and subsequent management of a patient with DMD caused by the leading haptic of a foldable intraocular lens (IOL) during its insertion.

A 50-year-old woman underwent coaxial phacoemulsification for age-related cataract in her right eye. Descemet membrane detachment was noted during the insertion of the foldable posterior chamber IOL through a temporal 2.2-mm incision. Corneal edema did not resolve by the third postoperative day. Scheimpflug photography demonstrated a complete separation between the posterior stroma and DM along the entirety of the cornea. Surgical intervention was performed on the fourth postoperative day, which involved creation of stab incisions into the pre-Descemet space along with intracameral air injection.

Successful apposition of the DM followed by clearing of corneal edema was observed within 1 week.

Our case report highlights the potential complication of DM detachment during insertion of foldable IOL. We performed stab incisions in the pre-DM space to achieve quick and successful repositioning of the detached DM with favorable results.