Anterior Segment Optical Coherence Tomography-Guided Management Algorithm for Descemet Membrane Detachment After Intraocular Surgery

Purpose:To evaluate the role of anterior segment optical coherence tomography (ASOCT) in the detection and management of Descemet membrane detachment (DMD) in cases of persistent corneal edema after intraocular surgery. An ASOCT-guided new algorithm for the management of such DMDs is described.Methods:Thirty-seven consecutive cases of persistent corneal edema of more than 2-week duration after intraocular surgery were included. All cases referred had no response to medical therapy. ASOCT was performed in all eyes. DMDs that were in the superior half of the cornea with a planar configuration alone were managed using intracameral air, and those with scrolled edges were managed using intracameral 14% perfluoropropane (C3F8). DMDs that were in the inferior half of the cornea with planar or scrolled edges were managed using intracameral C3F8 injection. The parameters evaluated were the type and morphology of DMD, resolution of DMD, and best-corrected visual acuity.Results:Using ASOCT, DMD was found to be present in 25 eyes. All cases had planar edges, and 52% (13/25) cases had scrolled edges. In 48% (12/25) cases, DMD was peripheral. Descemetopexy with intracameral air or 14% C3F8 gas showed resolution in all cases with the mean time to resolution being 16.0 7.1 days.Conclusions:ASOCT is a useful tool for timely diagnosis, characterization, and management of DMD in cases of nonresolving postoperative corneal edema. A new algorithm for intracameral injection of air or C3F8 in these cases helps to defer corneal transplantation.