Late Descemet membrane detachment (DMD) after cataract surgery in eyes with prior Descemet Membrane Endothelial Keratoplasty (DMEK) is an uncommon but serious complication which can occur months after the uneventful cataract surgery. Typically, DMD after routine cataract surgery occurs days to weeks postoperatively and may result from fluid misdirection, surgical trauma, or inadequate graft adherence. Even minor intraoperative manipulation, such as irrigation near the graft edge, can disrupt the delicate interface between the donor Descemet membrane and host stroma. However in the cases presented here, it happened months later.
Patients may present with decreased vision, corneal edema, or graft folds. Anterior segment optical coherence tomography (AS-OCT) is essential for confirming the diagnosis. Small, peripheral detachments may resolve spontaneously, but larger or central detachments often require re-bubbling with an air or gas tamponade to reappose the graft. Prompt recognition and intervention are critical to restoring corneal clarity and preventing graft failure. Surgeons should handle DMEK grafts with extreme care during cataract surgery and use minimal fluidics to avoid dislodging the membrane postoperatively.