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Published on: September 17, 2014
Anatomic and visual outcomes of descemetopexy in post-cataract surgery descemet's membrane detachment
Rajat Jain1, Somasheila I Murthy, Sayan Basu
1Cornea and Anterior Segment, L V Prasad Eye Institute, Hyderabad, India.
Objective:
To study the anatomic and visual outcomes of descemetopexy in Descemet's membrane detachment (DMD) after cataract surgery.
Design:
Retrospective case series.
Participants:
Clinical notes of 60 patients who underwent DMD after cataract surgery between 2007 and 2011.
Methods:
Descemetopexy was performed with air or 14% isoexpansile perfluoropropane (C3F8).
Main Outcome Measures:
Anatomical (reattachment rates) and functional results (best-corrected visual acuity) were studied. Secondary outcome measures were assessment of surgical complications and association of various factors with final visual outcome.
Results:
The mean age of the patients was 64.3 ± 8.3 years, and the male:female ratio was 21:39. At 1 month, the mean logarithm of the minimum angle of resolution (logMAR) interval visual acuity (IVA) improved from 1.27 ± 0.8 to 0.42 ± 0.49 (P < 0.001). Five patients (8.3%) obtained 20/20 vision, and 37 of 60 patients (61.6%) achieved IVA of ≥ 20/40. Ninety-five percent (57/60) of patients had successful reattachment of the Descemet's membrane (DM) after the intervention. Multiple linear regression analysis showed that patients with a cataract score of 5 (estimate = 0.38; P=0.014), with a cataract score of 4 with compromised visibility due to a corneal opacity (estimate = 0.45; P=0.039), and prolonged duration between cataract surgery and descemetopexy (estimate = 0.012; P=0.007) were associated with a significantly poorer final visual outcome. No association of final visual outcome was observed with age; sex; eye treated; cataract scores 2, 3, and 4; preoperative visual acuity; and involvement of the visual axis (P > 0.5). The eyes in which air was used for descemetopexy (estimate = -0.2; P=0.009) had statistically significantly better final visual outcomes. Three patients (5%) had treatment failures and required subsequent endothelial transplantation. Pupillary block was observed in the early postoperative period in 7 patients (11.66%) in whom C3F8 had been used and was not seen with air (P=0.02).
Conclusions:
This study suggests that DMD after cataract surgery can be treated effectively and good visual outcomes can be expected if the patient is treated in time with anterior chamber injection of gas. Air has advantages of better efficacy than C3F8 without the risk of pupillary block and thus should be preferred.
