Bilateral Descemet's membrane detachment after uneventful phacoemulsification in a case of diabetes mellitus
A 65-year-old male presented to our clinic for cataract surgery. He was a known case of diabetes mellitus since 5 years that was well controlled with oral antidiabetic drugs. The preoperative fasting and postprandial blood sugar status was found to be within normal limits. The preoperative best corrected visual acuity (BCVA) was 20/120 in the right eye and 20/80 in the left eye. The preoperative slit lamp biomicroscopic examination revealed posterior subcapsular cataract in both eyes. Fundus examination using indirect ophthalmoscope was normal in both eyes. Specular microscopy revealed a cell density of 1984/mm2 in the right eye and 1934/mm2 in the left eye, and coefficient of variation (CV) of 0.35 in the right eye and 0.32 in the left eye. Ultrasonic pachymetry revealed central corneal thickness of 0.57 mm in the right eye and 0.58 mm in the left eye.\nPatient underwent phacoemulsification and intraocular lens implantation under peribulbar anesthesia, using a temporal scleral tunnel approach in his right eye. A dispersive viscoelastic (sodium chondroitin sulfate, 4%; sodium hyaluronate, 3%) was used during the surgery considering the low cell count. No intraoperative complications were noted. On postoperative day 1, the BCVA in the right eye was 20/400. Slit lamp examination revealed diffuse corneal edema and DM detachment extending from the temporal sclerocorneal tunnel wound and involving most of the cornea. Anterior segment optical coherence tomography (OCT) was done for documentation []. The central corneal thickness was unrecordable. Considering the large extent of DM detachment, a decision was taken to do descemetopexy. On the same day, 14% C3F8 was injected into the anterior chamber of the right eye through inferotemporal limbal paracentesis track in the operation room. Visual acuity and central corneal thickness gradually improved to 20/40 and 0.586 mm, respectively, over a period of 3 weeks.\nTwo months after the first surgery, the patient underwent phacoemulsification and intraocular lens implantation in his left eye. The surgery was performed by the same surgeon with extreme caution, using a temporal scleral tunnel approach. A dispersive viscoelastic (sodium chondroitin sulfate, 4%; sodium hyaluronate, 3%) was used during the surgery. No intraoperative complications were noted. On first postoperative day, the visual acuity in his right eye was 20/40 and in the left eye was counting fingers at 3 feet. Slit lamp examination revealed diffuse corneal edema and DM detachment involving most of the cornea in his left eye. Anterior segment OCT was done for documentation []. The central corneal thickness was 0.896 mm in the left eye. On the same day, descemetopexy was done using 14% C3F8, injected into the anterior chamber through inferotemporal limbal paracentesis track. Postoperative period was uneventful. Visual acuity and central corneal thickness improved gradually to 20/30 and 0.596 mm, respectively, over a period of 3 weeks. In both eyes, C3F8 bubble took about 2 weeks to disappear completely from the anterior chamber. Anterior segment OCT photograph was taken in both eyes 3 weeks postoperatively [Figs. and ].