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

Singh, Ajit; Vanathi, Murugesan; Sahu, Suman; Devi, Sujata

doi:10.1136/bcr-2016-217268

Cited by 9 publications

(7 citation statements)

References 26 publications

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“…Minor DMD may be resolved spontaneously for some time. 10 Minkovitz JB. et al found that DMD without scrolling is more likely to recover spontaneously, but with scrolling should be repaired early by surgery.…”

Section: Discussionmentioning

confidence: 99%

Spontaneous resolution of recurrent Descemet's membrane detachment after trabeculectomy: A case report

Xiao

Chen

et al. 2022

American Journal of Ophthalmology Case Reports

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Purpose We report a rare case of recurrent Descemet's membrane detachment (DMD) post-trabeculectomy which was resolved spontaneously without surgical intervention. Observations A 66-year-old patient with a history of acute angle closure glaucoma in his right eye presented to our hospital. The intraocular pressure (IOP) of his right was 40 mm Hg, and the visual acuity was10/20. After trabeculectomy of the affected eye, a severe Descemet's membrane detachment was found by AS-OCT. Part of Descemet's membrane was lying in front of the iris and lens. Surgical repair was performed, and viscoelastics and sterile air were injected into the anterior chamber to return the detached Descemet's membrane. AS-OCT showed that the DMD was successfully resolved. However, on the 7th day of follow-up, the DMD was detached again as seen on AS-OCT images. The patient refused reoperation to repair the DMD. Six months later, the patient visited our hospital again, and, interestingly, the DMD was completely resolved spontaneously without reoperation. Conclusions and importance Descemet's membrane is the basement membrane that lies between the stroma and the endothelial layer of the cornea. Minor DMD may be resolved spontaneously within a period of time without surgery, but large DMD is difficult to recover spontaneously. We believe that this is a rare case with spontaneous recovery of extensive DMD after trabeculectomy. But, despite all this, we still remain of the view that DMD should be treated immediately once it occurs.

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Section: Discussionmentioning

confidence: 99%

Spontaneous resolution of recurrent Descemet's membrane detachment after trabeculectomy: A case report

Xiao

Chen

et al. 2022

American Journal of Ophthalmology Case Reports

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“…I-OCT could also be helpful in patients with ectopia lentis, preventing further corneal endothelium damage during lens removal [36,37].…”

Section: Discussionmentioning

confidence: 99%

Intraoperative Anterior Segment Optical Coherence Tomography in the Management of Cataract Surgery: State of the Art

Toro

Milan

Tognetto

et al. 2022

JCM

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Background: The introduction of non-invasive diagnostic tools in ophthalmology has significantly reshaped current clinical practice in different settings. Recently, different anterior segment (AS) intraoperative optical coherence tomography (i-OCT) systems have been employed for different interventional procedures including cataract surgery. Materials and Methods: A review on the use of AS i-OCT in the management of cataract surgery, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines (PRISMA). The level of evidence according to the Oxford Centre for Evidence-Based Medicine (OCEM) 2011 guidelines, and the quality of evidence according to the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system were assessed for all included articles. Results: Out of 6302 articles initially extracted, 6302 abstracts were identified for screening and 32 of these met the inclusion/exclusion criteria for full-text review; 19 articles were excluded. Conclusions: The use of AS i-OCT in cataract surgery, even if only a few studies have a high level or grade of evidence, may represent a useful tool for novel surgeons approaching phacoemulsification but also for expert ones for teaching purposes and to plan and manage complicated cases.

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“…And it could be resolved successfully by giving her surveillance until 8 weeks after surgery. 5,9 Several retrospective analysis studies have found that descemetopexy represents a safe and effective option (reapplication in 71-87.5% of cases), which is why opting for this option emerged as the safest in view of the high postoperative success rate. 3,9 However, there is no solid evidence about which gas to perform Descemetopexy.…”

Section: Discussionmentioning

confidence: 99%

“…They can be classified into three types: simple, symmetric and complete detachment. 4,5 Most detachments are peripheral and resolve spontaneously, large and central DMD, if not treated properly, can cause decompensation and opacification of the cornea. 6 Recently, Kumar et al developed an algorithm for classifying and assigning DMD treatment called HELP (Height, extent, length and pupil) based on the dimensions of the DMD measured by AS-OCT and its extension based on 3 corneal zones that the authors delimited.…”

Section: Introductionmentioning

confidence: 99%

<p>Descemet’s Membrane Detachment: An Intraoperative Complication in Cataract Surgery with Phacoemulsification</p>

González¹,

Silva²,

Barrientos³

et al. 2020

IMCRJ

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Descemet's membrane detachment (DMD) is a complication fundamentally associated with cataract surgery, the subclinical presentation being higher than expected. There are many varied treatments, from simple observation to penetrating keratoplasty. We present a case report of a 78-year-old male patient, without comorbidities, who underwent cataract surgery with phacoemulsification plus intraocular lens implantation in the capsular bag of the left eye. During the intraoperative procedure, he presented a DMD (height of 350 um and length of 3 mm in Zone 1 according to the HELP algorithm), managed with adaptive viscoelastic under the soft-shell technique in the same operative act, injection of iso-expansile SF6 (20%) intracameral plus postural positioning for 2 hours carried out 48 hours after surgery plus intensive topical treatment with hypertonic sodium chloride and steroidal anti-inflammatory drugs. At 72 hours after the operation of the application of the gas bubble, he presented with a transparent cornea and a bestcorrected visual acuity of 20/80, which finally for his ophthalmological control at 8 weeks presented definitive resolution of the case in the AS-OCT and with a BCVA of 20/30.

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

Cited by 9 publications

References 26 publications

Spontaneous resolution of recurrent Descemet's membrane detachment after trabeculectomy: A case report

Spontaneous resolution of recurrent Descemet's membrane detachment after trabeculectomy: A case report

Intraoperative Anterior Segment Optical Coherence Tomography in the Management of Cataract Surgery: State of the Art

<p>Descemet’s Membrane Detachment: An Intraoperative Complication in Cataract Surgery with Phacoemulsification</p>

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