Descemet Membrane Detachment During Foldable Intraocular Lens Implantation

Mannan, Rifat; Pruthi, Archna; Parkash, Rohit Om; Jhanji, Vishal

doi:10.1097/icl.0b013e31820c6fe7

Cited by 15 publications

(8 citation statements)

References 24 publications

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“…The common causes for DMD during or following a cataract surgery include inappropriate incision construction in the anterior clear cornea, use of blunt blades for incision construction, excessive manipulation and instrumentation, intraoperative shallowing of anterior chamber, misdirection of cannulas while injecting intracameral drugs or viscoelastics and difficult IOL insertion 9. In the present case, the risk factor was probably related to prolonged duration of surgery as per the clinical history which suggests extensive manipulation and instrumentation as a potential cause of DMD.…”

Section: Discussionmentioning

confidence: 62%

Intraoperative OCT assisted descemetopexy with stromal vent incisions and intracameral gas injection for case of non-resolving Descemet's membrane detachment

et al. 2017

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Descemet's membrane detachment (DMD) though uncommon in the present day scenario of advancing surgical techniques is a significant complication that requires prompt diagnosis and management. A middle-aged man presented to our hospital with poor gain of vision following cataract surgery. There was significant corneal oedema with DMD which was confirmed on anterior segment optical coherence tomography. We describe a modified continuous intraoperative-guided approach for the management of DMD in cases with oedematous hazy corneas. The aim of this technique is to allow early reattachment of Descemet's membrane in chronic cases where fluid pockets prevent reattachment of the posterior layer of cornea. Our technique involves the use of full thickness stromal vent incisions in the paracentral cornea along with intracameral isoexpansile concentration of gas for the successful settlement of the detached Descemet's membrane.

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Section: Discussionmentioning

confidence: 62%

Intraoperative OCT assisted descemetopexy with stromal vent incisions and intracameral gas injection for case of non-resolving Descemet's membrane detachment

et al. 2017

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“…There are many types of intraocular surgeries such as phacoemulsification, trabeculectomy, deep sclerotomy, viscocanalostomy, holmium laser sclerostomy, deep anterior lamellar keratoplasty, endothelial keratoplasty, intracorneal ring segment implantation, and pars plana vitrectomy, that are known to result in DMD. [10][11][12][13][14][15][16][17][18] Among the most common causes of DMD are blunt keratomes, shelved or anteriorly placed incisions, shallow anterior chamber, inadvertent injection of saline, viscoelastic or antibiotics at the pre-Descemetic space such as during irrigation-aspiration, stromal hydration, intraocular lens insertion, and intracameral antibiotic injection. [10][11][12][13][14][15][16][17][18] Other surgeries reported with DMD include laser peripheral iridotomy and surgical iridotomy.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of Descemet’s Membrane Detachment Using Anterior Segment Optical Coherence Tomography

Çağatay¹,

Ekinci²,

Koban³

et al. 2014

tjo

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We report the use of anterior segment optical coherence tomography (ASOCT) in Descemet's membrane detachment (DMD). A patient who developed DMD after uneventful cataract surgery with posterior chamber lens implantation is presented in this case report. At the follow-up examination after cataract surgery, slit-lamp evaluation showed stromal striae, but it was impossible to diagnose the DMD due to the corneal edema. ASOCT imaging of the cornea revealed a DMD, and the patient underwent intracameral air injection to the anterior chamber through the site which was identified as intact by ASOCT. Follow-up ASOCT imaging revealed the reattachment of the Descemet's membrane and reduced corneal thickness. If DMD is suspected in any cases, ASOCT can be useful to document and follow the postsurgical detachment of DMD and also to determine the site, configuration, and extent of the DMD, thus guiding the treatment method and monitoring the treatment outcome.

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“…Damage to Descemet's membrane can occur due to various factors during cataract surgery, including engaging of Descemet's membrane by the leading haptic during IOL implantation[6] or with the irrigation/aspiration device (when mistaken as an anterior capsular remnant)[7] or due to inadvertent injection of viscoelastic between Descemet's membrane and corneal stroma. [8] Repair techniques include manual repositioning,[9] repositioning with viscoelastic[9] or air,[9] suturing of Descemet's membrane to the peripheral cornea[9] or use of SF 6 [8] or C 3 F 8 .…”

Section: Discussionmentioning

confidence: 99%

Descemet′s tear due to injector cartridge tip deformity

Biswas¹,

Sengupta²,

Paul³

et al. 2012

Indian J Ophthalmol

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Foldable intraocular lens (IOL) implantation using an injector system through 2.8-mm clear corneal incision following phacoemulsification provides excellent speedy postoperative recovery. In our reported case, a Sensar AR40e IOL (Abbott Medical Optics, USA) was loaded into Emerald C cartridge, outside the view of the operating microscope, by the first assistant. The surgeon proceeded with the IOL injection through a 2.8-mm clear corneal incision after uneventful phacoemulsification, immediately following which he noted a Descemet's tear with a rolled out flap of about 2 mm near the incision site. Gross downward beaking of the bevelled anterior end of the cartridge was subsequently noticed upon examination under the microscope. We suggest careful preoperative microscopic inspection of all instruments and devices entering the patient's eyes to ensure maximum safety to the patient.

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Descemet Membrane Detachment During Foldable Intraocular Lens Implantation

Abstract: Our case report highlights the potential complication of DM detachment during insertion of foldable IOL. We performed stab incisions in the pre-DM space to achieve quick and successful repositioning of the detached DM with favorable results.

Cited by 15 publications

References 24 publications

Intraoperative OCT assisted descemetopexy with stromal vent incisions and intracameral gas injection for case of non-resolving Descemet's membrane detachment

Intraoperative OCT assisted descemetopexy with stromal vent incisions and intracameral gas injection for case of non-resolving Descemet's membrane detachment

Evaluation of Descemet’s Membrane Detachment Using Anterior Segment Optical Coherence Tomography

Descemet′s tear due to injector cartridge tip deformity

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