Procedural Adjustments Can Reduce Descemet Membrane Detachments

Surgical instrument friction appeared to have the greatest association with incisional Descemet membrane detachment, a common cataract surgery complication, according to a study published in JAMA Ophthalmology. 

That same research also shows  that decreasing ultrasonic energy and phacoemulsification time possibly reduced incisional Descemet membrane detachment severity.

The consecutive, prospective case series looked at 133 patients, aged 50 to 90 years old, who had a cataract and were having coaxial 2.2 mm clear corneal microincision phacoemulsification with IOL implantation. They assessed for incision-related incision-related Descemet membrane detachment at every stage of surgery.

They found that in the 133 patients, Descemet membrane detachment occurred in 125 eyes, or 94%, at these times during surgery: capsulorrhexis (2 [1.6%]), hydrodissection (7 [5.6%]), phacoemulsification (69 [55.2%]), irrigation-aspiration (44 [35.2%]), and IOL implantation (3 [2.4%]).

“The extent of [Descemet membrane detachment] increased during the operation (mean [SD] difference between final and initial relative [Descemet membrane detachment] length, 22.8% [1.4%]; 95% CI, 20.0-25.6; P <.001),” according to investigators. “Associations for the extent of [Descemet membrane detachment] found in multivariate stepwise analyses included time of ultrasonography (β=0.34; 95% CI, 0.17 to 0.50; P <.001), equivalent mean ultrasonic power (β=87.8; 95% CI, 19.1 to 156.4; P =.01), and the presence of Descemet membrane detachment at the anterior and posterior wound margins (coefficient=16.7; 95% CI, 6.4 to 26.9; P =.002).”

The study did have limitations, including that only age-related cataract cases were included, so other cataract cases were excluded, as were patients with corneal lesions, and only one type of corneal incision was studied. “To evaluate the profile and prognosis of intraoperative incision-related [Descemet membrane detachment] more comprehensively, patients with a wider range of cataract causes (eg, traumatic, metabolic, and inflammatory), corneal pathologies (especially lower corneal en- dothelial cell density and corneal endothelial defects), and corneal incisions of different architecture should be studied,” the study shows.

Reference

Dai Y, Liu Z, Wang W, et al. Real-time imaging of incision-related descemet membrane detachment during cataract surgery. JAMA Ophthalmol. Published online December 10, 2020. doi:10.1001/jamaophthalmol.2020.5396