Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub. X:X | DOI: 10.5507/bp.2026.026

Descemet membrane detachment during phacoemulsification. A Review

Bulir Petra, b, Studeny Pavelb
a Eye Department, Regional Hospital, Liberec, Czech Republic
b Clinic of Ophthalmology, University Hospital Kralovske Vinohrady and 3rd Faculty of Medicine, Charles University, Prague, Czech Republic

Descemet membrane detachment (DMD) is an uncommon but clinically significant complication of cataract surgery, particularly phacoemulsification. This review summarizes current evidence on the incidence, risk factors, diagnosis, and management of DMD associated with cataract surgery. A narrative literature review identified 28 relevant publications between 1995 and 2025 across PubMed Medline, Cochrane Library Database, and Scopus, including retrospective and prospective studies, review articles, and case reports.

Most cases of DMD result from mechanical trauma at the clear corneal incision site, although spontaneous detachments have also been reported. Recognized risk factors include poor incision architecture, repeated or forceful instrument manipulation, blunt surgical instruments, elevated ultrasound energy, and limited surgical experience. Advances in anterior segment optical coherence tomography (AS-OCT) have significantly improved detection and classification, particularly in cases obscured by corneal edema.

Management depends on the extent and morphology of detachment. Small, peripheral, and planar detachments may resolve with conservative treatment, whereas extensive, central, or scrolled detachments usually require surgical intervention, most commonly descemetopexy with intracameral air or gas tamponade. Careful wound construction, meticulous surgical technique and prompt diagnosis are essential to reduce the incidence and visual consequences of this complication.

Keywords: descemet membrane detachment, cataract surgery, phacoemulsification, clear corneal incision, anterior segment OCT

Received: April 12, 2026; Revised: July 22, 2026; Accepted: August 12, 2026; Prepublished online: August 25, 2026 

Share...
Download citation
  • BibTeX (.bib)
  • Bookends (.ris)
  • EasyBib (.ris)
  • EndNote (.enw)
  • EndNote 8 (.xml)
  • ISI WoS (.isi)
  • Medlars (.medlars)
  • Mendeley (.ris)
  • MODS (.xml)
  • Papers (.ris)
  • RefWorks (.txt)
  • RefManager (.ris)
  • RIS (.ris)
  • MS Word (.xml)
  • Zotero (.ris)
    • Open full article

    References

    1. Kansal S, Sugar J. Consecutive Descemet membrane detachment after successive phacoemulsification. Cornea 2001;20(6):670-1. Go to original source...
    2. Felipe AF, Rapuano CJ, Nottage JM, Abazari A. Descemet membrane detachment among siblings: role of anatomic and familial predisposition. Cornea 2012;31(7):848-50. Go to original source...
    3. Singhal D, Sahay P, Goel S, Asif MI, Maharana PK, Sharma N. Descemet membrane detachment. Surv Ophthalmol 2020;65(3):279-93. Go to original source...
    4. Samuels B. Detachment of Descemet's membrane. Trans Am Ophthalmol Soc 1928;26:427-37.
    5. Mackool RJ, Holtz SJ. Descemet membrane detachment. Arch Ophthalmol 1977;95(3):459-63. Go to original source...
    6. Assia EI, Levkovich-Verbin H, Blumenthal M. Management of Descemet's membrane detachment. J Cataract Refract Surg 1995;21(6):714-7. Go to original source...
    7. Jain R, Murthy SI, Basu S, Ali MH, Sangwan VS. Anatomic and visual outcomes of descemetopexy in post-cataract surgery Descemet membrane detachment. Ophthalmology 2013;120(7):1366-72. Go to original source...
    8. Jacob S, Agarwal A, Chaudhry P, Narasimhan S, Chaudhry VN. A new clinico-tomographic classification and management algorithm for Descemet's membrane detachment. Cont Lens Anterior Eye 2015;38(5):327-33. Go to original source...
    9. Kumar DA, Agarwal A, Sivanganam S, Chandrasekar R. Height-, extent-, length-, and pupil-based (HELP) algorithm to manage post-phacoemulsification Descemet membrane detachment. J Cataract Refract Surg 2015;41(9):1945-53. Go to original source...
    10. Sharma N, Gupta S, Maharana PK, Shanmugam P, Nagpal R, Vajpayee RB. Anterior segment optical coherence tomography-guided management algorithm for Descemet membrane detachment after intraocular surgery. Cornea 2015;34(9):1170-4. Go to original source...
    11. Ti SE, Chee SP, Tan DT, Yang YN, Shuang SL. Descemet membrane detachment after phacoemulsification surgery: risk factors and success of air bubble tamponade. Cornea 2013;32(4):454-9. Go to original source...
    12. Sharma N, Bandivadekar P, Agarwal T, Shah R, Titiyal JS. Incision-site Descemet membrane detachment during and after phacoemulsification: risk factors and management. Eye Contact Lens 2015;41(5):273-6. Go to original source...
    13. Chaves MAPD, de Medeiros AL, Vilar CMC, Magalhães KRP, Gonçalves MR, Tzelikis PFDM, et al. Architecture evaluation of the main clear corneal incisions in femtosecond laser-assisted cataract surgery by optical coherence tomography imaging. Clin Ophthalmol 2019;13:365-72. Go to original source...
    14. Benatti CA, Tsao JZ, Afshari NA. Descemet membrane detachment during cataract surgery: etiology and management. Curr Opin Ophthalmol 2017;28(1):35-41. Go to original source...
    15. Grewal DS, Basti S. Comparison of morphologic features of clear corneal incisions created with a femtosecond laser or a keratome. J Cataract Refract Surg 2014;40(4):521-30. Go to original source...
    16. Nosé RM, Rivera-Monge MD, Forseto AS, Nosé W. Descemet membrane detachment in femtosecond laser-assisted cataract surgery. Cornea 2016;35(4):562-4. Go to original source...
    17. Cennamo M, Favuzza E, Salvatici MC, Giuranno G, Buzzi M, Mencucci R. Effect of manual, preloaded, and automated preloaded injectors on corneal incision architecture after IOL implantation. J Cataract Refract Surg 2020;46(10):1374-80. Go to original source...
    18. Dai Y, Liu Z, Wang W, Qu B, Liu J, Congdon N, He M, Luo L, Liu Y. Real-Time Imaging of Incision-Related Descemet Membrane Detachment During Cataract Surgery. JAMA Ophthalmol 2021;139(2):150-155. doi: 10.1001/jamaophthalmol.2020.5396 Go to original source... Go to PubMed...
    19. Dai Y, Liu Z, Wang W, Han X, Jin L, Chen X, Jin G, Wang L, Zhang E, Qu B, Liu J, Congdon N, He M, Luo L, Liu Y. Incidence of Incision-Related Descemet Membrane Detachment Using Phacoemulsification With Trapezoid vs Conventional 2.2-mm Clear Corneal Incision: A Randomized Clinical Trial. JAMA Ophthalmol 2021;139(11):1228-1234. doi: 10.1001/jamaophthalmol.2021.4148 Go to original source... Go to PubMed...
    20. Chen X, Ji Y, Lu Y. Comparison of clear corneal incision injuries between torsional and conventional phacoemulsification. Graefes Arch Clin Exp Ophthalmol 2013;251(9):2147-54. Go to original source...
    21. Lee H, Kim EK, Kim HS, Kim TI. Fourier-domain optical coherence tomography evaluation of clear corneal incision structure according to blade material. J Cataract Refract Surg 2014;40(10):1615-24. Go to original source...
    22. Titiyal JS, Kaur M, Ramesh P, Shah P, Falera R, Bageshwar LMS, Kinkar A, Sharma N. Impact of Clear Corneal Incision Morphology on Incision-Site Descemet Membrane Detachment in Conventional and Femtosecond Laser-Assisted Phacoemulsification. Curr Eye Res 2018;43(3):293-299. doi: 10.1080/02713683.2017.1396616 Go to original source... Go to PubMed...
    23. Ho FL, Salowi MA, Bastion MLC. The effect of eye patching on clear corneal incision architecture in phacoemulsification: a randomized controlled trial. Asia Pac J Ophthalmol (Phila) 2017;6(5):429-34.
    24. Vasavada AR, Johar KS, Praveen MR, Vasavada VA, Arora AI. Histomorphological and immunofluorescence evaluation of clear corneal incisions after microcoaxial phacoemulsification with 2.2 mm and 1.8 mm systems. J Cataract Refract Surg 2013;39(4):617-23. Go to original source...
    25. Xu J, Chen X, Wang H, Yao K. Safety of femtosecond laser-assisted cataract surgery versus conventional phacoemulsification for cataract: a meta-analysis and systematic review. Adv Ophthalmol Pract Res 2022;2(1):100027. Go to original source...
    26. Ventura BV, Ventura MC. Managing Descemet detachment in femtosecond laser-assisted cataract surgery: the isolate-and-release technique. J Refract Surg 2016;32(2):136. Go to original source...
    27. Osman EA. The benefit of ultrasound biomicroscopy in management of total Descemet's membrane detachment after deep sclerectomy surgery. Int Ophthalmol 2011;31(4):345-8. Go to original source...
    28. Couch SM, Baratz KH. Delayed bilateral Descemet's membrane detachments with spontaneous resolution: implications for nonsurgical treatment. Cornea 2009;28(10):1160-3. Go to original source...
    29. Yuksel E, Cubuk MO, Ceylanoglu KS. Intracameral air injection after completion of phacoemulsification cataract surgery: evaluation of corneal incisions with optical coherence tomography. J Curr Ophthalmol 2019;31(2):142-9. Go to original source...
    30. Odayappan A, Shivananda N, Ramakrishnan S, Krishnan T, Nachiappan S, Krishnamurthy S. A retrospective study on the incidence of post-cataract surgery Descemet's membrane detachment and outcome of air descemetopexy. Br J Ophthalmol 2018;102(2):182-6. Go to original source...
    31. Chaurasia S, Ramappa M, Garg P. Outcomes of air descemetopexy for Descemet membrane detachment after cataract surgery. J Cataract Refract Surg 2012;38(7):1134-9. Go to original source...
    32. Akin T, Ayata A, Aykan U, Bilge AH. Intracameral perfluoropropane (C3F8) gas in the repair of extensive Descemet's membrane detachment during phacoemulsification surgery. Ophthalmic Surg Lasers Imaging 2010;41(2):1-3. Go to original source...
    33. Li F, Zhu Z, Fan L, Yi G, Zhu X, Li N. A simple repair algorithm for Descemet's membrane detachment performed at the slit lamp. J Clin Med 2022;11(23):7001. Go to original source...
    34. Chow JY, Akhtar Ali AN, Bastion MLC. Pneumodescemetopexy with a lower concentration of perfluoropropane (10% C3F8) in Descemet membrane detachment. Cureus 2021;13(8):e16985. Go to original source...
    35. Doi A, Akagi T, Tsujikawa A. Successful treatment of post-phacoemulsification Descemet's membrane detachment assessed by anterior segment optical coherence tomography: a case report. Case Rep Ophthalmol 2021;12(2):611-5. Go to original source...
    36. González AL, Silva F, Barrientos R, Paredes F. Descemet's membrane detachment: an intraoperative complication in cataract surgery with phacoemulsification. Int Med Case Rep J 2020;13:673-7. Go to original source...
    37. Gab-Alla AA. A comparative study between air bubble tamponade alone versus air bubble tamponade with internal fluid aspiration for nonplanar Descemet's membrane detachment after phacoemulsification. J Ophthalmol 2021;2021:6654819. Go to original source...
    38. Rathi H, Venugopal A, Rengappa R. Late-onset fluid-filled Descemet membrane detachment after cataract surgery managed with Nd:YAG laser. Case Rep Ophthalmol Med 2016;2016:7021863. Go to original source...
    39. Weng Y, Ren YP, Zhang L, Huang XD, Shentu XC. An alternative technique for Descemet's membrane detachment following phacoemulsification: case report and review of literature. BMC Ophthalmol 2017;17(1):109. Go to original source...
    40. Das M, Begum Shaik M, Radhakrishnan N, Prajna NV. Descemet membrane suturing for large Descemet membrane detachment after cataract surgery. Cornea 2020;39(1):52-5. Go to original source...

    This is an open access article distributed under the terms of the Creative Commons Attribution 4.0 International License (CC BY 4.0), which permits use, distribution, and reproduction in any medium, provided the original publication is properly cited. No use, distribution or reproduction is permitted which does not comply with these terms.


    Return