Eyeworld

I OCTOBER 2020 | EYEWORLD | 53 Contact Hovanesian: jhovanesian@harvardeye.com Jacob: dr_soosanj@hotmail.com Packer: mark@markpackerconsulting.com During the 2020 ASCRS Virtual Annual Meeting, an on-demand film by Chan- drashekhar Wavikar, MD, Wavikar Eye Institute, Thane, India, and colleagues titled "A Killer Wave Surviving Descemet's Detachment" explored the complication of a Descemet's detachment in a cataract surgery case. Dr. Wavikar detailed cataract surgery on a 65-year-old male patient who had a well-dilated pupil and no other risk factors. During surgery, Dr. Wavikar had com- pleted his rhexis when he noticed a Descem- et's detachment. He immediately did a sideport incision on the opposite side and started injecting viscoelastic under the Descemet's mem- brane, flattening it against the cornea. He proceeded with gradual hydrodissection, trying not to disturb the anterior chamber too much. He kept injecting viscoelastic to ensure that the Descemet's membrane did not fall down. When beginning phaco, Dr. Wavikar was cautious and used low parameters, starting with a direct chop. But since the vac- uum was low, direct chop wasn't possible, so he shifted to a four-quadrant technique. He noted that he was doing phaco inside the capsular bag as much as possible to be away from the Descemet's membrane. While implanting the lens, the tip of the cartridge was inserted into the anterior chamber, and the lens was implanted in two steps. The trailing haptic was introduced into the bag, and air was introduced into the anterior chamber (far from the detachment). Dr. Wavikar noticed his sideports were leaking, so he had to use several stiches. Air was then introduced to hyperinflate the an- terior chamber to raise IOP to a significant level. The patient rested in that same position for some time. Dr. Wavikar noted several instances that may cause increased chance of Descemet's membrane detachment. This could occur because of a difficult surgery, for example, deep set eyes or a shallow anterior cham- ber. Specific factors that could increase the incidence include blunt instruments, improp- er direction during insertion, and viscodis- section. Viscodissection was to blame in this case, Dr. Wavikar said. The lesson learned is to insert the can- nula well into the anterior chamber before injecting viscoelastic. He also noted that with careful, slow surgery, you can complete the surgery successfully, even with the complica- tion of Descemet's detachment. Attendees of the 2020 ASCRS Virtual Annual Meeting can find the film from Dr. Wavikar on demand. Relevant disclosures Wavikar: None Contact Wavikar: drcmwavikar@wavikareye.com OCT image of Descemet's detachment Source: Chandrashekhar Wavikar, MD Viscoelastic as a complicating factor "While limited Descemet's detachments imme- diately anterior to a clear corneal incision are common and usually do not require any special treatment, large detachments can persist and require secondary intervention," said Mark Packer, MD. In the case he shared, viscoelastic was inadvertently injected anterior to Descem- et's membrane, resulting in a complete detach- ment and corneal edema. The presence of viscoelastic was a complicating factor, however, gentle irrigation and instillation of air resulted in complete resolution.

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