Repair of Descemet’s membrane detachment following inadvertent intrastromal viscoelastic injection for hypotony: anterior and posterior approaches

Descemet's membrane (DM) detachment is a significant, if rare, risk of intracameral injection of viscoelastic to treat hypotony after glaucoma filtration surgery. We describe two cases of DM detachment following inadvertent injection of viscoelastic into the posterior stroma and the techniques used for their repair. In both cases, conventional air tamponade failed to resolve the detachment, and further surgical intervention was required. One underwent anterior drainage through venting incisions performed in the operating theatre, while the other had posterior drainage through the DM performed on the slit lamp. Both cases had complete resolution with a good visual outcome and preservation of the glaucoma surgery. Management of this type of detachment requires close coordination between corneal and glaucoma specialists, and the surgical option selected should be tailored to the specific detachment. When managed appropriately, a good visual outcome can be achieved without needing corneal graft surgery and minimising the bleb scarring process.