Intraoperative Oct Observation Of Incision-Related Descemet Membrane Detachment After Implantable Collamer Lens Implantation

To investigate the intraoperative occurrence of DMD at the 3.0mm transparent corneal incision site during the ICL implanation and analyse the related factors.

Participants were recruited from patients who underwent ICL implanation at Wuhan Bright Eye Hospital.

A prospective study was conducted on 120 myopia patients (120 eyes) who underwent ICL implanation at Wuhan Bright Eye Hospital from June 1, 2022 to December 1, 2022. There were 52 males and 68 females, with an age range of 21 to 45 years and a mean age of 26.04±5.28 years. A 3.0 mm transparent corneal incision was made in the upper right eye, and intraoperative OCT was used to observe and measure the incidence and extent of incision-related DMD at each step of the surgery.

Among the 120 patients (120 eyes), 98 eyes (81.6%) had DMD, which occurred during the following steps: incisional creation (2[2%]), lens implantation (18[18.4%]), lens repositioning (20[20.4%]), and washing the anterior chamber before flushing (58[59.1%]). During the surgery, the increase in DMD in each step of the operation was observed in real-time with intraoperative OCT (average [SD] difference between initial and final relative DMD length, 23.2% [1.6%]; 95% confidence interval, 20.6-24.7; P<0.01). Factors related to the degree of DMD in multivariate analysis included the angle of lens implantation (P<0.05), the angle of lens repositioning (P<0.01), the angle of anterior chamber flushing (P<0.01), and the duration of flushing (P<0.01).

Intraoperative OCT can be used to observe the angle of anterior chamber flushing flow in real-time during surgery, which is most closely related to incisional DMD. Adjusting the angle of anterior chamber flushing flow, reducing the duration of flushing, adjusting the angle of lens implantation, and reducing the duration of lens repositioning can effectively reduce the incidence and severity of incisional DMD.