We have covered the topic of the rules for an ideal phaco incision and one of them is to barely intersect the limbal vessels in order to get a tiny amount of bleeding. This helps the incision seal well and allows it to heal far better than a totally avascular incision. But sometimes, the incision starts a little bit in the conjunctiva and that can cause issues if the infusion fluid goes into this opening.
The force of the infusion fluid will allow balanced salt solution to balloon up the conjunctiva and this will spread around the limbus until there is 360° of chemosis. This puffy, inflated conjunctiva will allow fluid to accumulate on top of the cornea which will then adversely affect the view through the cornea for the cataract surgery.
The solution is simple: use a sharp instrument such as the paracentesis blade to make multiple small, radial fenestrations in the conjunctiva. These openings will allow the trapped fluid to escape and the surgery can then proceed normally.
Click below to see conjunctival chemosis and its management:
All content is ©2018 by Uday Devgan MD. All rights reserved.