Real-Time Imaging of Incision-Related Descemet Membrane Detachment During Cataract Surgery

Ye Dai, Zhenzhen Liu, Wei Wang, Bo Qu, Jianping Liu, Nathan Congdon, Mingguang He, Lixia Luo, Yizhi Liu

Research output: Contribution to journalArticlepeer-review

3 Citations (Scopus)
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Importance: Incision-related Descemet membrane detachment (DMD) is a common complication of cataract surgery. Most postoperative severe DMD that leads to corneal decompensation originates from intraoperative incision-related DMD. It is important to determine the incidence, extent, and associated risk factors of intraoperative DMD at each step of surgery to help in formulating precise and effective prevention strategies.

Objectives: To investigate the intraoperative development of incision-site DMD associated with a 2.2-mm clear corneal incision during cataract surgery and to analyze its associated factors.

Design, Setting, and Participants: In this case series, consecutive, prospectively enrolled 133 patients with cataract 50 to 90 years of age (133 eyes) undergoing coaxial 2.2-mm clear corneal microincision phacoemulsification with intraocular lens (IOL) implantation between January 1 and March 31, 2019, at Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China, were studied.

Exposures: Coaxial 2.2-mm clear corneal microincision phacoemulsification with IOL implantation.

Main Outcomes and Measures: Real-time incidence and extent of intraoperative incision-related DMD at each step of surgery.

Results: Among 133 patients with cataracts (mean [SD] age, 72.3 [8.1] years; 77 [57.9%] female), DMD was encountered in 125 eyes (94.0%), occurring at the following steps: capsulorrhexis (2 [1.6%]), hydrodissection (7 [5.6%]), phacoemulsification (69 [55.2%]), irrigation-aspiration (44 [35.2%]), and IOL implantation (3 [2.4%]). The extent of DMD increased during the operation (mean [SD] difference between final and initial relative DMD length, 22.8% [1.4%]; 95% CI, 20.0-25.6; P < .001). Associations for the extent of DMD found in multivariate stepwise analyses included time of ultrasonography (β = 0.34; 95% CI, 0.17-0.50; P < .001), equivalent mean ultrasonic power (β = 87.8; 95% CI, 19.1-156.4; P = .01), and the presence of DMD at the anterior and posterior wound margins (coefficient = 16.7; 95% CI, 6.4-26.9; P = .002).

Conclusions and Relevance: The results of this case series suggest that friction of surgical instruments has the greatest association with incisional DMD. Decreasing ultrasonic energy and phacoemulsification time may reduce the severity of incisional DMD.

Original languageEnglish
Pages (from-to)150-155
Number of pages6
JournalJAMA Ophthalmology
Issue number2
Early online date10 Dec 2020
Publication statusPublished - 01 Feb 2021


  • Aged
  • Aged, 80 and over
  • Cataract/therapy
  • Corneal Injuries/diagnostic imaging
  • Descemet Membrane/diagnostic imaging
  • Female
  • Friction
  • Humans
  • Incidence
  • Male
  • Microscopy, Video
  • Middle Aged
  • Phacoemulsification/adverse effects
  • Postoperative Complications/diagnostic imaging
  • Predictive Value of Tests
  • Prospective Studies
  • Risk Factors
  • Time Factors
  • Tomography, Optical Coherence
  • Treatment Outcome


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