ESCRS - CR13 - OPTIONS FOR THE CATARACT SURGEON IN DM INJURY AT CATARACT SURGERY

OPTIONS FOR THE CATARACT SURGEON IN DM INJURY AT CATARACT SURGERY

Published 2023 - 27th ESCRS Winter Meeting

Reference: CR13 | Type: Case Report (Cornea Day) | DOI: 10.82333/72sr-8387

Authors: Cristina Cristian* 1 , Abhinav Loomba 1 , Sid Goel 2

1Ophthalmology,Hull University Teaching Hospitals,Hull,United Kingdom, 2Ophthalmology,Hull University Teaching Hospitals,HULL,United Kingdom

Purpose

Descemet's detachment (DD) is a common complication following cataract surgery and it can occur in up to 43% of cataract surgeries. Most times the injury is peripheral and resolves spontaneously. Large, central DDs if not managed appropriately may lead to corneal decompensation and visual damage. 8% of these require a corneal transplant. We demonstrate through this case example, options for cataract surgeons to allow for early resolution without progressing to transplant surgery. 

Setting

University Teaching Hospital

Report of case

A 77-year-old male patient underwent routine right cataract surgery. Post operatively his BCVA was counting fingers. The patient had non-resolving generalised cornea oedema with normal intraocular pressure. The DM was seen to be detached but anatomically in situ. This was likely to have happened from vigorous wound hydration at the end of the cataract operation. Descemetopexy with air was performed following the principles of endothelial keratoplaty and the patient postured after the procedure. Anatomical and functional success were achieved. His cornea became clear and his vision improved to normal levels. Clinical pictures and videos illustrate this patient’s journey

Conclusion / Take home message

Early recognition and surgical intervention of a DM detachment at cataract surgery is likely to enable resolution without the need for a tranplant . If suspected at the end of surgery, anterior chamber air insertion is recommended which should resolve the issue. We would note that separated DM can mimic a retained anterior capsule flap. Care must be taken when considering removal of any clear membranes at the end of cataract surgery.