Posters

Ocular hypotonia in cataract surgery as a risk factor for Descemet's membrane detachment: the importance of the order of the incisions

Poster Details

First Author: J.Folch Ramos SPAIN

Co Author(s): R. Salvador   E. Ribas Coll                 

Abstract Details

Purpose:

To determine whether ocular hypotonia when performing the main incision in cataract surgery -due to previously performed paracentesis- may influence intra- or post-surgery descemet membrane detachment (DD) development, and if so, whether this could be a maneuver to be avoided. Secondly, to observe whether the intraocular lens and type of injector may also have any influence in this postoperative complication; and, finally, to determine whether anterior chamber depth (ACD) plays also a role.

Setting:

Germanes Hospitalàries del Sagrat Cor de Jesus “Hospital Sant Rafael”, Barcelona

Methods:

Prospective study with 75 consecutive cataract surgeries divided in 2 groups, depending on whether paracentesis was performed before 2.75 mm main incision (group 1) or the other way round (group 2). Any degree of DD observed during surgery or a week later at slit lamp or by OCT was evaluated. 3 different type of lenses (B&L MI60, ALCON SN60AT, J&J TECNIS) were implanted, and overall DD was also analyzed in these groups. Finally, we evaluated any possible relation between ACD (measured during biometry)  and DD development.

Results:

Overall, DD was observed in 52% of the cases, 61.54 % in group 1 (paracentesis first) and 41.66% in group 2 (main incision in the first place). These differences were only statistically significant at the time of surgery, being only a tendency in one week postoperative evaluation, but  without statistical significance (p-value = 0.085). Regarding the lens implanted, DD was observed in 46.16% of cases with Alcon lens, 44% with J&J lens and 66.6% with B&L lens, although these differences were again not statistically significant. Finally,  there was no association between ACD and DD development.

Conclusions:

Our study suggests a tendency towards DD in those cases in which main incision is performed in a hypotonic eye (group 1). Probably, differences were statistically significant only in intraoperative observations (p-value = 0.02512) due to self-resolution of DD during the first postoperative week (as there were no clinically significant DDs), and so, performing paracentesis prior to main incision would be a maneuver to be avoided. This study also suggests that neither the type of lens implanted nor ACD plays a role in DD development, but larger studies should be advisable in order to confirm these tendencies.

Financial Disclosure:

... gains financially from competing product or procedure, ... travel has been funded, fully or partially, by a company producing, developing or supplying the product or procedure presented, ... research is funded, fully or partially, by a company producing, developing or supplying the product or procedure presented, ... receives non-monetary benefits from a company producing, developing or supplying the product or procedure presented, ... receives consulting fees, retainer, or contract payments from a company producing, developing or supplying the product or procedure presented, ... is employed by a competing company, ... has significant investment interest in a company producing, developing or supplying product or procedure presented