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A fluid mechanical explanation of the spontaneous reattachment of a previously detached Descemet membrane

Ismail Z, Fitt AD, Please CP

Math Med Biol, 2013 Dec;30(4):339-55.
PMID: 23054933 DOI: 10.1093/imammb/dqs028

Descemet membrane detachment (DMD) is a rare but potentially serious surgical complication that arises most often during cataract surgery. A recent study (Couch, S. M. & Baratz, K. H. (2009) Cornea, 28, 1160-1163) cited the case of a patient with DMDs in both eyes, noting that though one detachment was surgically repaired, the other spontaneously reattached and needed no further treatment. A fluid mechanical model of buoyancy-driven aqueous humour flow in the anterior chamber around a DMD is developed to explain this phenomenon. The analytical model is based on the lubrication theory limit of the Navier-Stokes equations. The flow is determined for a fixed geometry and the possible motion of the DMD is then analysed. Numerical calculations are also carried out (using COMSOL© Multiphysics) to confirm the lubrication theory results. The analytical and numerical results both show that, under the correct conditions, either spontaneous reattachment or worsening of the tear may occur. We conclude that it is possible that clinical outcomes for DMDs may be controlled by adjusting the temperature difference across the eye and/or the orientation of the patient.

Matched MeSH terms: Descemet Membrane/physiopathology*
Descemetorhexis for Fuchs' dystrophy

Moloney G, Chan UT, Hamilton A, Zahidin AM, Grigg JR, Devasahayam RN

Can J Ophthalmol, 2015 Feb;50(1):68-72.
PMID: 25677286 DOI: 10.1016/j.jcjo.2014.10.014

To describe 2 cases of spontaneous corneal clearing after Descemetorhexis: 1 after iatrogenic trauma (Case 1) and 1 as an intentional surgical intervention for Fuchs endothelial dystrophy (Case 2).

Matched MeSH terms: Descemet Membrane/injuries; Descemet Membrane/surgery*
The Effect of Eye Patching on Clear Corneal Incision Architecture in Phacoemulsification: A Randomized Controlled Trial

Ho FL, Salowi MA, Bastion MC

Asia Pac J Ophthalmol (Phila), 2017;6(5):429-434.
PMID: 28379650 DOI: 10.22608/APO.2016198

PURPOSE: To investigate the effects of postoperative eye patching on clear corneal incision architecture in phacoemulsification.
DESIGN: A single-center, randomized controlled trial.
METHODS: A total of 132 patients with uncomplicated phacoemulsification were randomly allocated to the intervention or control group. The intervention group received postoperative eye patching for approximately 18 hours, whereas the control group received eye shield. The clear corneal incision architecture was examined postoperatively at 2 hours, 1 day, and 7 days after surgery using optical coherence tomography.
RESULTS: Epithelial gaping was significantly reduced on postoperative day 1 in the intervention group (52.4%) compared with control (74.2%) (P = 0.01). No differences were found for other architectural defects. Descemet membrane detachment was associated with lower intraocular pressure on postoperative day 7 (P = 0.02). Presence of underlying diabetes mellitus did not seem to influence architectural defects.
CONCLUSIONS: Postoperative eye patching facilitated epithelial healing and reduced the occurrence of epithelial gaping on postoperative day 1. It may play a role in protecting and improving corneal wounds during the critical immediate postoperative period.

Matched MeSH terms: Descemet Membrane/pathology
Fulltext Descemet membrane detachment postphacoemulsification

Muhammad Najmi, K., Logeswary, K., Rona Asnida, N., Wan Haslina Wah, Umi Kalthum, M.N., Aida Zairani, M.Z.

Medicine & Health, 2018;13(1):208-214.
MyJurnal

We report the case series of phacoemulsification-related Descemet membrane detachment (DMD) encountered at a tertiary hospital in Kuala Lumpur. Case 1 was an iatrogenic DMD which was detected intraoperatively and managed early with good outcome. Case 2 and case 3 described unusual presentation of DMD which was initially undiagnosed. This report highlights the use of anterior segment optical coherence tomography (ASOCT) in detecting and confirming the correct diagnosis for DMD. With the aid of an experienced corneal specialist, the higher threshold for suspicious occurrence of DMD was confirmed using ASOCT. Treatment was tailored accordingly, with successful clearance of corneal oedema and visual recovery. This case series highlighted the importance of proper operative documentation and high threshold for suspicion for DMD in focal corneal oedema following an otherwise uneventful cataract surgery. It is concluded that ASOCT is an excellent tool to confirm diagnosis of DMD and success of treatment.

Matched MeSH terms: Descemet Membrane
Hemorrhagic Descemet Membrane Detachment Following Syphilitic Interstitial Keratitis

Höllhumer R, Zairani Mz A, Watson S

Cornea, 2016 Sep;35(9):1255-6.
PMID: 27227396 DOI: 10.1097/ICO.0000000000000889

PURPOSE: Syphilitic interstitial keratitis is a stromal inflammatory disease with characteristic secondary vascularization. This case illustrates a late complication of hemorrhagic Descemet membrane detachment.
METHODS: Case report.
RESULTS: The patient presented with painless sudden visual loss and progressive shallowing of the anterior chamber caused by hemorrhagic Descemet membrane detachment. She had corneal neovascularization and a positive syphilis serology. Owing to the risk of pupil block glaucoma, the patient had surgical drainage of the blood via an ab externo approach.
CONCLUSIONS: This case illustrates a previously unreported complication of syphilitic interstitial keratitis. The patient recovered good visual acuity and had residual pigment deposits in the pre-Descemet interface.

Matched MeSH terms: Descemet Membrane/pathology*