In this challenging scenario, the surgeon inserts infusion to attempt a hydro-implantation of the IOL but then a distinct line is seen across the eye. What is it? Stop reading now if you want to guess!
The infusion cannula inadvertently enters the potential space between the stroma and the corneal endothelium, leading to a significant Descemet’s membrane detachment (DMD). The line observed during the quiz is the characteristic scrolled or taut edge of the detached membrane as it separates from the posterior stroma. This is a critical surgical complication that requires immediate recognition to prevent further stripping of the membrane or permanent corneal edema. Management involves immediate cessation of fluid infusion through the cannula to stop the expansion of the detachment. The surgeon should then fill the anterior chamber with a cohesive ophthalmic viscosurgical device to tamponade the membrane back against the stroma. At the conclusion of the case, a 100% air or dilute sulfur hexafluoride (SF6 16%) gas bubble is typically injected into the anterior chamber to provide long-term pneumopexy. This ensures the membrane remains apposed to the stroma, allowing the endothelial pump to clear the cornea and facilitate reattachment.
