When we make a phaco incision that involves the cornea, there is always a risk of having focal detachment of Descemet’s membrane. This happens due to incision architecture, bringing instruments in/out of the incision, and due to the patient’s anatomy and tissue response. When this happens, we can detect it by looking carefully at the incision site.
The OCT imaging shows the presence of a focal detachment in Descemet’s membrane at the incision site. This small defect can be addressed by inflating the eye with balanced salt solution which should push this flap back into position. The the endothelial pump function will keep the flap adherent to the corneal stroma. For larger defects, injecting an air bubble can help provide further support to keep Descemet’s membrane in position. The air bubble can be 100% room air or a combination of air plus a small amount of SF6 gas (such as 16% SF6 with 84% room air by using 0.5cc of SF6 with 2.5cc of room air).
In this case, a membrane appears to be stuck inside the phaco incision. But there is more to the story. Watch the video to learn more.
click below to learn more about Descemet membrane detachments:
Sir if it is full corneal thickness suture,when will it be removed?Do advice any precautions apart from normal suturing? Thank you.
You should not do full-thickness corneal sutures. When you remove a full thickness corneal suture there is a tract through which aqueous can leak. at most do 90% corneal depth sutures.
Thank you very much sir.Sir how can we be sure that Descements membrane is included while suturing cornea to reattach DM during DM stripping?
the suture is to close the cornea and should be 80% depth. Then Descemets membrane will attach as long as you push it towards the intended area, either with just BSS or use an air/gas bubble. The suture does not go through Descemets membrane.
Sir how long can we do an air injecting for replacing Descemet striping post operatively