title: Descemet membrane detachment after phacoemulsification surgery: risk factors and success of air bubble tamponade.
abstract: OBJECTIVE
  To evaluate the efficacy of air bubble (AB) tamponade for Descemet membrane detachment (DMD) after clear corneal incision phacoemulsification surgery and to evaluate the risk factors for DMD.
  
  
  METHODS
  This is a retrospective analysis of patients with DMD managed with AB tamponade, within 42 postoperative days (PODs), over a 4-year period. Data collected were as follows: demographics, cataract density (Lens Opacities Classification System III), visual acuity, AB technique, clinical outcome, and total surgeries over the time period. Successful end points were DM reattachment and corneal clarity. Risk factors were assessed using a case-control study, with univariate and multivariate logistic regression analyses (significance at P < 0.05).
  
  
  RESULTS
  Incidence rate of DMD was 0.044% per year. Sixteen patients (mean age of 76 years) had AB tamponade for DMD, with corneal clarity restored in 14 cases (87.5%; n = 11 with 1 AB procedure, n = 3 with 2 AB procedures). The main clear corneal incision was the major site of DMD (n = 14, 87.5%). Pre-AB visual acuity was 20/100 and at 1 month, 20/40. Corneal clarity occurred by 30 days (range: 4-82 days) and remained clear throughout the median follow-up of 12.9 months. Significant univariate factors were as follows: age >65 years, nuclear sclerosis grade ≥4 (Lens Opacities Classification System III), preexisting endothelial disease, and first POD corneal edema. Multivariate logistic regression analyses revealed endothelial disease (odds ratio = 18.66) and first POD edema (odds ratio = 7.88) as significant independent risk factors for DMD occurrence (P < 0.05).
  
  
  CONCLUSIONS
  AB tamponade for DMD effectively restored corneal clarity in 87.5% of cases (14 of 16 eyes). Significant risk factors included endothelial disease and first POD corneal edema.
authors.affiliation: Singapore National Eye Centre, Singapore, Singapore. ti.seng.ei@snec.com.sg
authors.forename: Seng-Ei
authors.initials: SE
authors.lastname: Ti
authors.forename: Soon-Phaik
authors.initials: SP
authors.lastname: Chee
authors.forename: Donald T H
authors.initials: DT
authors.lastname: Tan
authors.forename: You-Nian
authors.initials: YN
authors.lastname: Yang
authors.forename: Stephanie L
authors.initials: SL
authors.lastname: Shuang
mesh_terms: D000208:Acute Disease; D000368:Aged; D000369:Aged, 80 and over; D016022:Case-Control Studies; D003316:Corneal Diseases / Q000209:etiology / Q000601:surgery*; D015715:Corneal Edema / Q000209:etiology; D003886:Descemet Membrane / Q000601:surgery*; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D018918:Phacoemulsification / Q000009:adverse effects*; D011183:Postoperative Complications; D012189:Retrospective Studies; D012307:Risk Factors; D014792:Visual Acuity