Spontaneous attachment of complex Descemet's membrane detachment following multiple failed interventions.

Area of Science:

• Ophthalmology
• Corneal Surgery
• Regenerative Medicine

Background:

• Descemet membrane detachment (DMD) can occur post-operatively, particularly after complex cataract surgery.
• Surgical interventions, such as intracameral air injection, are common but not always successful in reattaching the Descemet membrane.
• The pre-Descemet's layer (PDL) can also be involved in detachment, complicating management.

Observation:

• A 60-year-old female patient experienced a total Descemet membrane detachment (DMD) during complicated cataract surgery.
• Two surgical attempts using intracameral air injection, guided by Anterior Segment Optical Coherence Tomography (ASOCT) and Intra-operative Optical Coherence Tomography (iOCT), failed to reapproximate the detached tissues.
• The detachment involved both the Descemet membrane (DM) and the pre-Descemet's layer (PDL).

Findings:

• Despite failed surgical interventions, spontaneous reattachment of the Descemet membrane (DM) and pre-Descemet's layer (PDL) was observed.
• This spontaneous apposition occurred over a three-month period.
• Anterior Segment Optical Coherence Tomography (ASOCT) confirmed the successful spontaneous attachment.

Implications:

• This case demonstrates the potential for spontaneous resolution of complex Descemet membrane detachments (DMD), even when involving the pre-Descemet's layer (PDL).
• It suggests that conservative management or observation may be a viable option in select cases of persistent DMD after surgical failure.
• Further research is warranted to understand the mechanisms behind spontaneous Descemet membrane reattachment and its predictability.