I need your input to determine when this surgeon is getting / causing a Descemet detachment during cataract surgery. This is from an experienced surgeon who makes a good incision, but is still experiencing a focal Descemets detachment more than would be expected. Do you think the issue is the incision architecture or the way that instruments are going through it? Watch the video and please give your input — as a group, we can crowd-source the brains of so many surgeons.
Hi Dr. Devgan:
My guess would be:
– the edge of the cystitome / bent needle scratching the Descemets as it goes in or out of the wound.
– the probe with infusion on when going into the eye propagates the DM separation further
I think DM detachments happen more commonly than we think!
Hello. it is due to the incision structure. A sudden downward angle change while making the second plane of a biplanar incision with keratome leads to this trouble in weak corneas.
Descemet Detachments are tricky. Surgeons point to wound integrity (which is definitely a factor) or infusion “on” went entering the eye. The surgeon didn’t send his whole video, but I believe that when the eye is not being operated in primary position is a significant reason for Descemet detachments. We see this during the capsulorrhexis in the video with the cystitome. If the eye is tilted nasally, it is going to be more easier “to clip” descemet’s membrane. I wonder if this surgeon would have less detachments if he focuses on keep the eye in primary position. In my experience, I have an increase rate of Descemet detachments in hyperopic eyes where I am trying to avoid touch the iris as I move in and out of the incision which causes me to position instruments more anteriorly (and eye not in primary position).
Great comments. Very insightful. Thank you.