Be careful of the DM!

𝘋𝘦𝘴𝘤𝘦𝘮𝘦𝘵'𝘴 𝘔𝘦𝘮𝘣𝘳𝘢𝘯𝘦 𝘋𝘦𝘵𝘢𝘤𝘩𝘮𝘦𝘯𝘵⁣ ⁣ Intraoperative complication during intraocular surgery especially cataract surgery that may lead to corneal decompensation⁣ ⁣ 𝘔𝘰𝘴𝘵 𝘤𝘰𝘮𝘮𝘰𝘯 𝘤𝘢𝘶𝘴𝘦: Mechanical separation near the incision site by an instrument, fluid or viscoelastic substance⁣

⁣ 𝘖𝘵𝘩𝘦𝘳 𝘙𝘪𝘴𝘬 𝘧𝘢𝘤𝘵𝘰𝘳𝘴:⁣ ⁣ ● Shallow AC⁣ ● Anatomical predisposition⁣ ● Complicated surgeries⁣ ● Blunt blades⁣ ● Catching the DM during IOL implantation/ irrigation and aspiration⁣ ● Congenital glaucoma⁣ ● Keratoconus⁣



⁣ 𝐂𝐥𝐚𝐬𝐬𝐢𝐟𝐢𝐜𝐚𝐭𝐢𝐨𝐧:⁣ ⁣ 1. 𝘔𝘢𝘤𝘬𝘰𝘰𝘭 𝘢𝘯𝘥 𝘏𝘰𝘭𝘵𝘻 (𝘉𝘢𝘴𝘦𝘥 𝘰𝘯 𝘤𝘭𝘪𝘯𝘪𝘤𝘢𝘭 𝘱𝘳𝘦𝘴𝘦𝘯𝘵𝘢𝘵𝘪𝘰𝘯):⁣ ⁣ ● Planar → < 1mm separation from stroma (can resolve spontaneously)⁣ ● Non- Planar → > 1mm separation from stroma (should be repaired early)⁣ ⁣ 2. 𝘋𝘳. 𝘑𝘢𝘤𝘰𝘣’𝘴 (𝘉𝘢𝘴𝘦𝘥 𝘰𝘯 𝘦𝘵𝘪𝘰𝘱𝘢𝘵𝘩𝘰𝘨𝘦𝘯𝘦𝘴𝘪𝘴):⁣ ⁣ ● Stripped DM (during viscoelastic injection or insertion of blunt instruments)⁣ ● Taut DM⁣ - A long-standing stripped descemet’s membrane detachment could sometimes adhere to intraocular contents with secondary fibrosis, thus turning into a taut descemet’s membrane detachment.⁣ - It could be due to inflammation involving descemet's membrane, secondary incarceration of descemet's membrane in an inflammatory process⁣ ⁣ 3. 𝘔𝘰𝘳𝘱𝘩𝘰𝘭𝘰𝘨𝘪𝘤𝘢𝘭:⁣ ⁣ ● DMD with non scrolled edges⁣ ● DMD with scrolled edges⁣ ⁣ 𝐒𝐥𝐢𝐭 𝐋𝐚𝐦𝐩 𝐄𝐱𝐚𝐦𝐢𝐧𝐚𝐭𝐢𝐨𝐧:⁣ ⁣ Diffuse corneal edema can be present⁣ ⁣ 𝐈𝐦𝐚𝐠𝐢𝐧𝐠:⁣ ⁣ Anterior Segment OCT ⁣ Ultrasound Biomicroscopy (UBM)⁣ ⁣ 𝐌𝐚𝐧𝐚𝐠𝐞𝐦𝐞𝐧𝐭:⁣ ⁣ ● Conservative → Topical steroids, Hyperosmotic agents⁣ ⁣ ● Surgical →⁣ a. Internal Tamponade with air⁣ b. Descemetopexy with C3F8 and SF6⁣ c. Transcorneal suturing⁣ d. Descemetotomy⁣ e. Endothelial/ Penetrating Keratoplasty⁣ ⁣ www.ophthalmobytes.com

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