Look carefully at this picture and in particular that line at the tip of the yellow arrow. What is going on here and why is this a catastrophe? Stop reading unless you want to know the answer….
This is a large Descemet’s membrane detachment (DMD) which is going to result in counting fingers vision in the immediate post-op period. It is a complication that can occur during routine cataract surgery, particularly during wound construction, phacoemulsification, or irrigation/aspiration. In this case it happens to extend after IOL insertion when the IA instruments enlarge it. It results from inadvertent separation of Descemet’s membrane from the corneal stroma, often due to improper incision entry, use of dull blades, or misdirected fluid infusion. Clinically, a large DMD may present intra-operatively as corneal striae, loss of red reflex, or visible membrane scrolling. Postoperatively, patients may exhibit corneal edema and decreased vision. Immediate recognition is critical. Small detachments may resolve spontaneously with conservative management, but extensive or planar separations require intra-cameral air or gas (SF₆ or C₃F₈) tamponade to reattach the membrane. Gentle anterior chamber reformation and avoidance of further trauma are essential. Prevention involves meticulous wound architecture, correct instrument handling, and ensuring that all fluid cannulas are directed away from the corneal endothelium during surgery. When did you first notice the problem?