Advancing descemetopexy with real-time intraoperative optical coherence tomography for failed Descemet membrane detachment repositioning

PURPOSE: The aim of this study was to investigate the efficacy of real-time intraoperative optical coherence tomography (i-OCT) in improving the rate of Descemet membrane (DM) repositioning in cases of failed descemetopexy for Descemet membrane detachment (DMD). METHODS: We retrospectively reviewed the medical records and anterior segment optical coherence tomography images of patients for whom DMD repositioning failed and who visited our hospital between December 2023 and May 2025. All patients had complex DMD and underwent repositioning procedures guided by i-OCT. The causes of previous repositioning failures were analyzed on the basis of the i-OCT findings, and appropriate surgical maneuvers were employed to anatomically reposition the DM. RESULTS: Sixteen patients (6 males and 10 females; mean age 69.4 ± 9.5 years) were included. The number of previous repositioning attempts ranged from 1 to 3. Common causes of repositioning failure include residual viscoelastic material, DM adhesion to the iris or intraocular lens surface, and DM rigidity. Successful DM repositioning was achieved for all patients under i-OCT guidance. Postoperatively, significant improvements in best-corrected visual acuity, central corneal thickness, and intraocular pressure were observed. CONCLUSION: Real-time i-OCT is a powerful method for improving the rate of DM repositioning in patients for whom descemetopexy previously failed. This method enables precise surgical interventions, leading to better anatomical outcomes. Future studies with larger cohorts are needed to further explore the potential of i-OCT in ophthalmic surgeries.