Intraoperative Quantification of Incision-Site Descemet Membrane Detachment During Phacoemulsification: A Paired-Eye...

To quantify the extent of clinically non-significant Descemet membrane detachment (DMD) at the clear corneal incision (CCI) during phacoemulsification and to compare its extent between longitudinal and torsional ultrasound modulation as a morphological marker of local tissue-instrument interaction.

In this prospective contralateral-eye comparative randomized study, 14 patients (28 eyes) undergoing bilateral cataract surgery were included. One eye received longitudinal and the fellow eye torsional ultrasound (Constellation system, Alcon). DMD was assessed intraoperatively using microscope video recordings under red reflex illumination. Still images were analyzed, and DMD area (mm²) at the internal wound was measured. Correlations with cumulative dissipated energy (CDE) was evaluated.

Incision-site DMD was detected in all analyzed cases (100%) using intraoperative red reflex-based visualization. Mean DMD area was 1.33 ± 0.43 mm² (longitudinal) and 2.37 ± 0.67 mm² (torsional), with a mean difference of 1.04 mm² ± 0.74 mm² (95% CI, 0.60-1.48). The paired analysis demonstrated a highly significant difference (p < 0.001). No correlation was found between DMD extent and CDE.

Clinically non-significant incision-site DMD appears to be a frequent intraoperative morphological phenomenon during phacoemulsification when assessed using sensitive visualization techniques. Torsional ultrasound was associated with a significantly greater DMD extent than longitudinal modulation. Rather than indicating greater clinical damage, DMD area may serve as a sensitive quantitative morphological marker of local tissue-instrument interaction at the corneal incision. Its potential value therefore lies primarily in the comparative evaluation and future refinement of phacoemulsification technologies, while the clinical significance of these subtle morphological differences remains to be established.