When we construct our corneal phaco incisions, we must be careful to give them the proper architecture and form. We have covered this topic in much detail, here, here, and here, however this is another important consideration: how we bring instruments in and out of the eye.
When we insert a bulky instrument that is a tight fight with the incision, such as the phaco probe or the IOL injector, we must avoid damaging the cornea. If our instrument scrapes the roof of the incision, it can get caught on the edge of Descemet’s membrane and then induce a focal detachment. In rare cases this can even induce a larger scroll of detachment and cause persistent corneal failure.
The key in managing a small, focal Descemet’s membrane detachment is to seal the incision well and make sure that the tissues are re-approximated. The endothelial cell pump function will help adhere the detachment back into position. If the incision is leaking at all, then placing a 10-0 nylon suture to secure the wound is recommended. For larger detachments, injecting an air bubble inside the anterior chamber at the end of the surgery can provide further support, though this is a temporary measure.
Click below to watch this edited video of a Descemet’s detachment at the phaco incision: