Descemet membrane detachment during phacoemulsification. A Review

Descemet membrane detachment (DMD) is an uncommon but clinically significant complication of cataract surgery, particularly phacoemulsification. This review summarizes current evidence on the incidence, risk factors, diagnosis, and management of DMD associated with cataract surgery. A narrative literature review identified 28 relevant publications between 1995 and 2025 across PubMed Medline, Cochrane Library Database, and Scopus, including retrospective and prospective studies, review articles, and case reports. Most cases of DMD result from mechanical trauma at the clear corneal incision site, although spontaneous detachments have also been reported. Recognized risk factors include poor incision architecture, repeated or forceful instrument manipulation, blunt surgical instruments, elevated ultrasound energy, and limited surgical experience. Advances in anterior segment optical coherence tomography (AS-OCT) have significantly improved detection and classification, particularly in cases obscured by corneal edema. Management depends on the extent and morphology of detachment. Small, peripheral, and planar detachments may resolve with conservative treatment, whereas extensive, central, or scrolled detachments usually require surgical intervention, most commonly descemetopexy with intracameral air or gas tamponade. Careful wound construction, meticulous surgical technique and prompt diagnosis are essential to reduce the incidence and visual consequences of this complication.