A fluid mechanical explanation of the spontaneous reattachment of a previously detached Descemet membrane.

Descemet membrane detachment (DMD) is a rare but potentially serious surgical complication that arises most often during cataract surgery. A recent study (Couch, S. M. & Baratz, K. H. (2009) Cornea, 28, 1160-1163) cited the case of a patient with DMDs in both eyes, noting that though one detachment was surgically repaired, the other spontaneously reattached and needed no further treatment. A fluid mechanical model of buoyancy-driven aqueous humour flow in the anterior chamber around a DMD is developed to explain this phenomenon. The analytical model is based on the lubrication theory limit of the Navier-Stokes equations. The flow is determined for a fixed geometry and the possible motion of the DMD is then analysed. Numerical calculations are also carried out (using COMSOL© Multiphysics) to confirm the lubrication theory results. The analytical and numerical results both show that, under the correct conditions, either spontaneous reattachment or worsening of the tear may occur. We conclude that it is possible that clinical outcomes for DMDs may be controlled by adjusting the temperature difference across the eye and/or the orientation of the patient.