Eyeworld

I MY WORST COMPLICATION N FOCUS 52 | EYEWORLD | OCTOBER 2020 the wrinkles and the area where normal appear- ing light reflex off the bubble occurs. He suggested several strategies for dealing with this issue, including stroking the cornea from the surface in hope of milking some aque- ous from the cleft in the Descemet's membrane. He also mentioned using a Q-tip, but instead of rubbing , which would disrupt the epithelium, he said to use a rolling motion to get broader pressure across the surface of the cornea. You could also do a cut-down from the surface, but the danger is perforating the tear in Descemet's membrane and worsening the problem. not cause the Descemet's membrane to reat- tach in this case as the air bubble is not able to squeeze all the fluid out. Dr. Jacob shared a case where the bullous detachment occurred secondary to stromal hydration at the end of phaco surgery. As the stromal hydration was done at the needle entry sideport, the fluid pushed the Descemet's mem- brane down in a bullous configuration. Since the needle entry point was too small for the fluid to be pushed out, it did not respond to air injection, she said. The specific problems in this case, she said, were the needle prick entry wound and ab- sence of exit wound for trapped fluid to egress. Despite pneumodescemetopexy, there was fluid collection within the detached bullous Descem- et's membrane. Dr. Jacob's solution was to do a relaxing descemetotomy by creating a clean keratome entry cut through the Descemet's membrane and thus have an exit wound for the fluid to drain out from. The plan is to create an opening into the bullous base to allow a path for entrapped fluid to drain out, Dr. Jacob said. You can do this by creating a keratome entry through the bullous Descemet's detachment. The patient did well postoperatively in this case. Dr. Jacob stressed the importance of re- alizing that instead of repeated air injections in an attempt to treat a case of bullous Descemet's detachment, this entity should be recognized and treated immediately, effectively, and de- finitively during the primary surgery itself by following the strategy presented here. Strategies for handling Descemet's detachments John Hovanesian, MD, shared a case of De- scemet's membrane detachment, offering pearls on how to handle this issue as a whole and also what he did for this particular patient. In his case, he assumed the detachment had occurred from the temporal incision, likely from hydra- tion of the cornea at the end of the case. A Descemet's detachment defines itself nicely when air is put inside the eye, Dr. Hovanesian said, adding that you can see continued from page 51 Relevant disclosures Hovanesian: None Jacob: None Packer: None Dr. Packer shared an OCT image from his case, noting that viscoelastic was the cause of complete detachment. However, the issue was resolved with irrigation and instillation of air. Source: Mark Packer, MD Dr. Hovanesian noted that a Descemet's detachment will define itself nicely when air is put into the eye. Source: John Hovanesian, MD

• Blank Page
• Blank Page (1)