ENDOTHELIAL DETACHMENT IN FEMTOSECOND LASER-ASSISTED CATARACT SURGERY, AN UNEXPECTED COMPLICATION. A CASE REPORT.
Published 2022 - 26th ESCRS Winter Meeting
Reference: P018 | Type: Abstracts | DOI: 10.82333/2947-nk61
Authors: María Dolores Díaz-Barreda* 1 , Ana Boned-Murillo 1 , Guillermo Pérez-Rivasés 2 , Ismael Bakkali El Bakkali 2 , Pablo Cisneros-Arias 2 , Marta Orejudo-De Rivas 2 , Eva Núñez-Moscarda 2 , Julia Aramburu 2 , Marta Suñer 2 , Miguel Castillo 2 , Constanza Caramello 2 , Nuria López 2 , María Ángeles Del Buey-Sayas 2 , Enrique Mínguez 2 , Paula Casas 2 , Javier Ascaso 1
1Ophthalmology,Hospital Clínico Universitario Lozano Blesa (Zaragoza),Zaragoza,Spain;Department of Surgery,School of Medicine, University of Zaragoza,Zaragoza,Spain, 2Ophthalmology,Hospital Clínico Universitario Lozano Blesa (Zaragoza),Zaragoza,Spain
Purpose
To present an unexpected complication in femtosecond laser-assisted cataract surgery during the making of incisions.
Setting
The femtosecond laser can be used in cataract surgery, allowing us to create highly precise three-dimensional incisions according to their location, depth and shape, as well as to carry out a correct and perfectly controlled capsulorhexis and fragmentation of the crystalline lens.
Based on the phenomenon of photodisruption by optical decomposition, the laser generates ultra-short infrared pulses specifically in the focused plane. This allows it to ionise electrons that collide with each other, producing the vaporisation and mechanical modification of the tissue on which we want to act without affecting the immediately surrounding tissue. It also helps to minimise the energy required during phacoemulsification and thus minimises the loss of endothelial cells.
Methods
We present a femtosecond laser-assisted cataract surgery for the performance of the incisions (both paracentesis and main), capsulorhexis and lens fragmentation. During the making of the main incision, the energy and morphology planned for the femtosecond laser were not enough to achieve an adequate corneal perforation. The energy released by the photodisruption phenomenon generated an air bubble that was trapped between the corneal stroma and the Descemet in a perincisional location.
The manipulation generated by the surgeon during the first steps of the surgery, especially the injection of intracameral fluids and anaesthetics without being aware of the alteration in the incisional architecture, generated a large-scale detachment of Descemet's layer.
Results
During the otherwise uneventful phacoemulsification surgery, we noticed a significant endothelial loss as well as the surgeon's manoeuvres to try to adhere the Descemet's layer to the stroma once the problem was identified.
Conclusion
The femtosecond laser provides numerous advantages in cataract surgery, however, we must be prepared to deal with possible eventualities related to the application of the laser that may arise during surgery.