Diagnosing Descemet Membrane Detachment in Patients Undergoing Cataract Surgery using an AS-OCT-based HELP Algorithm: A Prospective Cross-sectional Study

Abstract

Introduction: Descemet Membrane Detachment (DMD) is a rare complication of cataract surgery which is more likely to occur during the learning curve especially during surgical training in residency. There are various methods of diagnosing DMD using slit lamp biomicroscopy, Ultrabiomicroscopy (UBM) and Anterior Segment Optical Coherence Tomography (AS-OCT). AS-OCT can be utilised to confirm, classify DMD and decide the plan of management by using Height, Length, Extent and Pupil (HELP) algorithm. Descemetopexy is the gold standard treatment in the management of DMD. The management of DMDs usually depends upon the site and extent of the detachment. Prompt diagnosis and timely management, leads to a good functional and anatomical outcome. Aim: To study the occurrence and management of DMDs during cataract surgeries using an AS-OCT-based HELP algorithm in a training hospital. Materials and Methods: This prospective cross-sectional study, included 25 eyes of 25 patients, who underwent cataract surgery which resulted in DMD in Bharati Vidyapeeth (Deemed to be University) Medical College and Hospital, Sangli, Maharashtra, India, from June 2021 to December 2021. AS-OCT-based HELP algorithm was used for diagnosis and determining, whether medical management needs to be done or surgical management. Either medical or surgical management (Descemetopexy) was done in all the 25 eyes. All the study subjects were followed up Postoperative Day (POD)- 1,7,30 for Descemet’s Membrane (DM) reattachment. The outcome measures were successful DM reattachment and/or improvement in visual acuity by atleast two Snellen lines. Paired t-test was used to test the mean difference between LogMAR visual acuity values pre and postoperatively. The p-value <0.05 was considered as statistically significant. Results: Out of 1008 cataract surgeries, 25 patients had DMD intraoperatively. The mean age of the patients was 61.12±7.29 years with a male:female ratio of 2:3. The most common surgery preceding DMD was Manual Small Incision Cataract Surgery (MSICS) (84%; n=21). The mean pre‑ and postmanagement visual acuities were 0.96±0.445 and 0.215±0.196, respectively (p<0.0001). A successful DM reattachment was seen in 92% (n=23) with the first attempt. There was a statistically significant improvement in visual acuity after management (p<0.0001). Conclusion: Management of DMD is crucial, as early diagnosis and treatment of patients with DMD leads to good visual outcome. AS-OCT-based HELP algorithm is very beneficial in the diagnosis of DMD. Descemetopexy is the gold standard in the management of DMD.

Keywords

• air bubble
• anterior segment optical coherence tomography
• descemetopexy
• perfluoropropane