Descemet membrane detachment (DMD) is a potential vision-threatening complication that occurs most commonly after
cataract surgery. DMD has also been reported to occur in various other surgeries such as
keratoplasty,
iridectomy,
vitrectomy,
trabeculectomy,
holmium laser sclerostomy,
alkali burn, and viscocanalostomy. Major risk factors include advanced age, preexisting endothelial diseases like
Fuchs dystrophy or abnormality in the Descemet membrane and stromal interface, hard
cataract, prolonged
surgical time, ragged clear corneal incisions, and inadvertent
trauma with blunt instruments or
phacoemulsification probe. Most DMDs are peripheral and resolve spontaneously. Large, central DMDs if not managed appropriately may lead to corneal decompensation and opacification. Several authors have classified DMD depending on its configuration, height, extent, length, and position with respect to pupil. Anterior segment optical coherence tomography has been used to confirm and classify DMD and can also aid in deciding the management plan. Spontaneous reattachment of the DM with
conservative management may occur in cases with small, peripheral, planar DMD with nonscrolled edges. Cases with nonplanar, central DMD, scrolled edges, and length >2 mm, however, have to be managed surgically. Descemetopexy is the gold standard for the management of DMD. Other management options include mechanical tamponade,
suture fixation, descemetotomy, interface drainage, and
keratoplasty. Prompt diagnosis and timely management often leads to a good visual outcome.