𝘋𝘦𝘴𝘤𝘦𝘮𝘦𝘵'𝘴 𝘔𝘦𝘮𝘣𝘳𝘢𝘯𝘦 𝘋𝘦𝘵𝘢𝘤𝘩𝘮𝘦𝘯𝘵 Intraoperative complication during intraocular surgery especially cataract surgery that may lead to corneal decompensation 𝘔𝘰𝘴𝘵 𝘤𝘰𝘮𝘮𝘰𝘯 𝘤𝘢𝘶𝘴𝘦: Mechanical separation near the incision site by an instrument, fluid or viscoelastic substance
𝘖𝘵𝘩𝘦𝘳 𝘙𝘪𝘴𝘬 𝘧𝘢𝘤𝘵𝘰𝘳𝘴: ● Shallow AC ● Anatomical predisposition ● Complicated surgeries ● Blunt blades ● Catching the DM during IOL implantation/ irrigation and aspiration ● Congenital glaucoma ● Keratoconus
𝐂𝐥𝐚𝐬𝐬𝐢𝐟𝐢𝐜𝐚𝐭𝐢𝐨𝐧: 1. 𝘔𝘢𝘤𝘬𝘰𝘰𝘭 𝘢𝘯𝘥 𝘏𝘰𝘭𝘵𝘻 (𝘉𝘢𝘴𝘦𝘥 𝘰𝘯 𝘤𝘭𝘪𝘯𝘪𝘤𝘢𝘭 𝘱𝘳𝘦𝘴𝘦𝘯𝘵𝘢𝘵𝘪𝘰𝘯): ● Planar → < 1mm separation from stroma (can resolve spontaneously) ● Non- Planar → > 1mm separation from stroma (should be repaired early) 2. 𝘋𝘳. 𝘑𝘢𝘤𝘰𝘣’𝘴 (𝘉𝘢𝘴𝘦𝘥 𝘰𝘯 𝘦𝘵𝘪𝘰𝘱𝘢𝘵𝘩𝘰𝘨𝘦𝘯𝘦𝘴𝘪𝘴): ● Stripped DM (during viscoelastic injection or insertion of blunt instruments) ● Taut DM - A long-standing stripped descemet’s membrane detachment could sometimes adhere to intraocular contents with secondary fibrosis, thus turning into a taut descemet’s membrane detachment. - It could be due to inflammation involving descemet's membrane, secondary incarceration of descemet's membrane in an inflammatory process 3. 𝘔𝘰𝘳𝘱𝘩𝘰𝘭𝘰𝘨𝘪𝘤𝘢𝘭: ● DMD with non scrolled edges ● DMD with scrolled edges 𝐒𝐥𝐢𝐭 𝐋𝐚𝐦𝐩 𝐄𝐱𝐚𝐦𝐢𝐧𝐚𝐭𝐢𝐨𝐧: Diffuse corneal edema can be present 𝐈𝐦𝐚𝐠𝐢𝐧𝐠: Anterior Segment OCT Ultrasound Biomicroscopy (UBM) 𝐌𝐚𝐧𝐚𝐠𝐞𝐦𝐞𝐧𝐭: ● Conservative → Topical steroids, Hyperosmotic agents ● Surgical → a. Internal Tamponade with air b. Descemetopexy with C3F8 and SF6 c. Transcorneal suturing d. Descemetotomy e. Endothelial/ Penetrating Keratoplasty www.ophthalmobytes.com
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