Descemet's Membrane Detachment with Schisis Induced by Phacoemulsification

Purpose. To describe a case of Descemet's membrane detachment and schisis (Descemet's membrane separated into multiple layers) with confirmation by high-definition anterior segment optical coherence tomography (AS-OCT) after phacoemulsification and intraocular lens implantation. Case Report. A 72-year-old woman presented with persistent corneal edema after phacoemulsification. She was diagnosed with herpes simplex keratitis and had been unsuccessfully treated for 60 days in her local hospital. Slit-lamp examination revealed moderate conjunctival injection, disciform-like stromal edema, and diffuse superficial punctate epithelial erosions. Descemet's membrane schisis and detachment with an interlayer tear were verified by high-definition AS-OCT. After 2 weeks of medication with topical 0.1% fluorometholone eye drops four times daily together with 3% ofloxacin eye ointment twice daily, Descemet's membrane was reattached with complete resolution of conjunctival injection, corneal edema, and epithelial erosions. Conclusions. This is a report of Descemet's membrane schisis in vivo that is documented and confirmed by high-definition AS-OCT. Descemet's membrane detachment and schisis caused by phacoemulsification can be misdiagnosed as herpetic keratitis due to stromal edema and epithelial erosion. Topical steroid and lubrication may help reattach Descemet's membrane to its original position.