Efficacy of Anterior Chamber Air Injection with Scleral Tunnel Peripheral Iridectomy for Descemet’s Membrane Detachment

This study aims to explore the effectiveness of iridotomy combined with anterior chamber insufflation for the treatment of Descemet's membrane detachment (DMD) through a scleral tunnel incision.

This is a retrospective study, analyzing 48 DMD patients treated at Hainan Eye Hospital, Zhongshan Ophthalmic Center, Sun Yat-sen University, from December 2012 to October 2024. Patients were divided into a conservative treatment group, a simple anterior chamber air injection group, and an anterior chamber air injection combined with peripheral iridectomy group through through scleral tunnel incision according to different treatment methods. Herein, the patient's preoperative visual acuity, corneal edema, and DMD recovery were observed and recorded on postoperative day 1, 7, and 1 month. Literature was retrieved related to DMD for the past 10 years, which was compared and analyzed for risk factors, treatment methods, and treatment outcomes.

The conservative treatment group consisted of 12 cases, with an average age of 73.0±10.7 (SD) years and an average recovery time of 13.7 days. There were 6 cases in the simple anterior chamber air injection group, with an average age of 68.6±8.5 (SD) years. On the first day after surgery, all cases of DMD had complete recovery. Among them, 3 cases had elevated intraocular pressure on the first day after surgery, and were treated with anterior chamber deflation and medication to reduce intraocular pressure. Two cases recovered to normal intraocular pressure 3 days after surgery, and 1 case developed ciliary ring block glaucoma. Posterior vitrectomy combined with peripheral iridectomy was performed to control intraocular pressure. Thirty cases of iris peripheral surgery combined with anterior chamber air injection group were considered, with an average age of 70.6±7.4(SD) years. On the first day after surgery, 2 cases had elevated intraocular pressure, which was restored through drug treatment. One week after surgery, one case of DMD did not recover, but was restored through corneal suturing and anterior chamber insufflation. The remaining 27 patients had normal intraocular pressure, DMD recovery, and resolution of corneal edema on the first day after surgery. In both the simple anterior chamber air injection group and the combination therapy group, there was one case of slight anterior chamber bleeding on the first day after surgery. Postoperative complication rates were significantly lower in the combined group (13.33%) compared to the simple injection group (83.33%, p=0.003).

Anterior chamber air injection effectively reattaches DMD, while adjunctive scleral tunnel iridectomy reduces the risks of postoperative angle closure and IOP elevation. The surgical approach avoids re-injury of DMD and minimizes complications.

Combined anterior chamber air injection and scleral tunnel peripheral iridectomy is a safe and effective treatment for DMD, with a low incidence of postoperative complications.