Guided intracameral air injection based on 3D reconstructed anterior optical coherence tomography images in iatrogenic Descemet's membrane detachment: Case report

RATIONALE: We emphasize the importance of using anterior optical coherence tomography (OCT) to understand the details of iatrogenic Descemet's membrane detachment (DMD) in 3 dimensions; this allows appropriate air injection into the anterior chamber in terms of both direction and method. PATIENTS CONCERNS: A 74-year-old Korean female presented with progressive visual impairment. On slit-lamp examination, an iridocorneal adhesion was observed, associated with a full-thickness corneal opacity 3.0-mm in diameter. Adherence between the crystalline lens (with moderate cortical cataracts) and the iris was evident near the opacity. Therefore, we decided to perform cataract surgery. DIAGNOSIS: Intraoperatively, iatrogenic DMD occurred during removal of the iridocorneal adhesion, as clearly shown on postoperative OCT. However, slit-lamp examination did not reveal the details of the DMD because of the corneal edema. INTERVENTIONS AND OUTCOMES: The DMD was evaluated via 3-dimensional (3D) reconstruction of multiple anterior OCT images. The reconstructed images were used to guide intracameral sterile air injection from an appropriate direction using an optimal method. The patient was asked to maintain an appropriate head position to allow the injected air to re-attach the DM. LESSONS: Three-dimensional (3D) reconstruction of an iatrogenic DMD developing during intraocular surgery is necessary to establish the details of the injury and allow accurate air injection into the anterior chamber; the air stream effectively re-attached the DM. It is important that the iatrogenic DMD can be treated properly only by confirming the accurate 3-dimensional shape as well as the position, height, and width of the DMD.