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Descemet Membrane Detachment After Phacoemulsification Surgery: Risk Factors and Success of Air Bubble Tamponade

Ti, Seng-Ei MMed(Ophth), FRCS(Ed); Chee, Soon-Phaik FRCS(Ed), FRCS(G); Tan, Donald T. H. FRCS(Ed), FRCS(G); Yang, You-Nian MPH; Shuang, Stephanie L. MStat

doi: 10.1097/ICO.0b013e318254c045
Clinical Science
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Purpose: To evaluate the efficacy of air bubble (AB) tamponade for Descemet membrane detachment (DMD) after clear corneal incision phacoemulsification surgery and to evaluate the risk factors for DMD.

Methods: This is a retrospective analysis of patients with DMD managed with AB tamponade, within 42 postoperative days (PODs), over a 4-year period. Data collected were as follows: demographics, cataract density (Lens Opacities Classification System III), visual acuity, AB technique, clinical outcome, and total surgeries over the time period. Successful end points were DM reattachment and corneal clarity. Risk factors were assessed using a case–control study, with univariate and multivariate logistic regression analyses (significance at P < 0.05).

Results: Incidence rate of DMD was 0.044% per year. Sixteen patients (mean age of 76 years) had AB tamponade for DMD, with corneal clarity restored in 14 cases (87.5%; n = 11 with 1 AB procedure, n = 3 with 2 AB procedures). The main clear corneal incision was the major site of DMD (n = 14, 87.5%). Pre-AB visual acuity was 20/100 and at 1 month, 20/40. Corneal clarity occurred by 30 days (range: 4–82 days) and remained clear throughout the median follow-up of 12.9 months. Significant univariate factors were as follows: age >65 years, nuclear sclerosis grade ≥4 (Lens Opacities Classification System III), preexisting endothelial disease, and first POD corneal edema. Multivariate logistic regression analyses revealed endothelial disease (odds ratio = 18.66) and first POD edema (odds ratio = 7.88) as significant independent risk factors for DMD occurrence (P < 0.05).

Conclusions: AB tamponade for DMD effectively restored corneal clarity in 87.5% of cases (14 of 16 eyes). Significant risk factors included endothelial disease and first POD corneal edema.

*Singapore National Eye Centre, Singapore, Singapore

Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.

Reprints: Seng-Ei Ti, Cornea Service, Singapore National Eye Centre, 11 Third Hospital Avenue, Singapore 168751, Singapore (e-mail: ti.seng.ei@snec.com.sg).

Presented (in part) at the European Society of Cataract and Refractive Surgeons Meeting, September 4–8, 2010, Paris, France.

The authors state that they have no financial interests to disclose.

Received December 14, 2011

Accepted March 4, 2012

Copyright © 2013 Wolters Kluwer Health, Inc. All rights reserved.