Descemet’s membrane detachment during cataract surgery-risk factors, management strategies, and outcomes

Session Details

Session Title: Corneal Endothelium & Cataract Surgery

Session Date/Time: Monday 24/09/2018 | 16:30-18:00

Paper Time: 17:27

Venue: Room A3, Podium 1

First Author: : D.Megur INDIA

Co Author(s): :    B. Megur                    

Abstract Details

Purpose:

To report the incidence of Descemet’s Membrane detachment (DM detachment) during Cataract Surgery and analyse the risk factors & also analyze the management outcomes.

Setting:

A private eye Hospital, Megur Eye Care Centre, Bidar ,Karnataka, India, in a southern state of India

Methods:

Prospective study, Period- Jan 2014 to mar 2017, All eyes undergoing Cataracts surgery (Phacoemulsificcation) at a single centre by a single surgeon during this period were included. The intraoperative events were documented. Diagnosis of DM detachment was made intra-operatively or post operatively & documented by slitlamp photography & AS OCT. The DM detachments were classified into small, medium or large. Eyes with moderate to large DM detachments were managed by using intra cameral air or expansile gas (SF 6 or C3F8). Primary outcome measures: The anatomical reattachment rates, visual outcomes. Secondary Outcome Measures: Complications of Gas Injection

Results:

Total number of eyes – 6500 eyes, Incidence of DM detachments moderate to large which required intervention-13 eyes (0.2%), MeanAge-77.923 +/- 5.619.Of the 13 eyes with DM detachment 5 eyes had superior detachment while 8 were inferior DM detachments. In 10 eyes DM detachment originated from the main phaco incision. Air was used in 5 eyes & 8 eyes received expansile gas (6eyes-SF6, 2 eyse-C3F8). Successful anatomic reattachment was achieved in 12 eyes, BCVA of 6/12 or better achieved in all the 13 eyes. 5 eyes with inferior DM detachment required more than 1 intervention. 3 eyes developed secondary glaucoma.

Conclusions:

Descemets Membrane Detachment during cataract surgery is a serious sight threatening complication, Elderly patients, eyes with corneal guttata & dense Arcus Senilis appear to be at risk for developing this complication, Inferior DM detachments were particularly difficult to manage & required multiple interventions and close monitoring. The anatomical reattachment rates and the visual outcomes were good with the use of intracameral expansile gas, however, risk of secondary pupillary block glaucoma exists. Anticipating the D M Detachment in high-risk patients is critical and taking surgical precautions may minimize the incidence of this serious complication.

Financial Disclosure:

-