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Be careful of the DM!

Updated: Nov 22, 2023

๐˜‹๐˜ฆ๐˜ด๐˜ค๐˜ฆ๐˜ฎ๐˜ฆ๐˜ต'๐˜ด ๐˜”๐˜ฆ๐˜ฎ๐˜ฃ๐˜ณ๐˜ข๐˜ฏ๐˜ฆ ๐˜‹๐˜ฆ๐˜ต๐˜ข๐˜ค๐˜ฉ๐˜ฎ๐˜ฆ๐˜ฏ๐˜ตโฃ โฃ Intraoperative complication during intraocular surgery especially cataract surgery that may lead to corneal decompensationโฃ โฃ ๐˜”๐˜ฐ๐˜ด๐˜ต ๐˜ค๐˜ฐ๐˜ฎ๐˜ฎ๐˜ฐ๐˜ฏ ๐˜ค๐˜ข๐˜ถ๐˜ด๐˜ฆ: Mechanical separation near the incision site by an instrument, fluid or viscoelastic substanceโฃ

โฃ ๐˜–๐˜ต๐˜ฉ๐˜ฆ๐˜ณ ๐˜™๐˜ช๐˜ด๐˜ฌ ๐˜ง๐˜ข๐˜ค๐˜ต๐˜ฐ๐˜ณ๐˜ด:โฃ โฃ โ— Shallow ACโฃ โ— Anatomical predispositionโฃ โ— Complicated surgeriesโฃ โ— Blunt bladesโฃ โ— Catching the DM during IOL implantation/ irrigation and aspirationโฃ โ— Congenital glaucomaโฃ โ— Keratoconusโฃ

โฃ ๐‚๐ฅ๐š๐ฌ๐ฌ๐ข๐Ÿ๐ข๐œ๐š๐ญ๐ข๐จ๐ง:โฃ โฃ 1. ๐˜”๐˜ข๐˜ค๐˜ฌ๐˜ฐ๐˜ฐ๐˜ญ ๐˜ข๐˜ฏ๐˜ฅ ๐˜๐˜ฐ๐˜ญ๐˜ต๐˜ป (๐˜‰๐˜ข๐˜ด๐˜ฆ๐˜ฅ ๐˜ฐ๐˜ฏ ๐˜ค๐˜ญ๐˜ช๐˜ฏ๐˜ช๐˜ค๐˜ข๐˜ญ ๐˜ฑ๐˜ณ๐˜ฆ๐˜ด๐˜ฆ๐˜ฏ๐˜ต๐˜ข๐˜ต๐˜ช๐˜ฐ๐˜ฏ):โฃ โฃ โ— Planar โ†’ < 1mm separation from stroma (can resolve spontaneously)โฃ โ— Non- Planar โ†’ > 1mm separation from stroma (should be repaired early)โฃ โฃ 2. ๐˜‹๐˜ณ. ๐˜‘๐˜ข๐˜ค๐˜ฐ๐˜ฃโ€™๐˜ด (๐˜‰๐˜ข๐˜ด๐˜ฆ๐˜ฅ ๐˜ฐ๐˜ฏ ๐˜ฆ๐˜ต๐˜ช๐˜ฐ๐˜ฑ๐˜ข๐˜ต๐˜ฉ๐˜ฐ๐˜จ๐˜ฆ๐˜ฏ๐˜ฆ๐˜ด๐˜ช๐˜ด):โฃ โฃ โ— Stripped DM (during viscoelastic injection or insertion of blunt instruments)โฃ โ— Taut DMโฃ - A long-standing stripped descemetโ€™s membrane detachment could sometimes adhere to intraocular contents with secondary fibrosis, thus turning into a taut descemetโ€™s membrane detachment.โฃ - It could be due to inflammation involving descemet's membrane, secondary incarceration of descemet's membrane in an inflammatory processโฃ โฃ 3. ๐˜”๐˜ฐ๐˜ณ๐˜ฑ๐˜ฉ๐˜ฐ๐˜ญ๐˜ฐ๐˜จ๐˜ช๐˜ค๐˜ข๐˜ญ:โฃ โฃ โ— DMD with non scrolled edgesโฃ โ— DMD with scrolled edgesโฃ โฃ ๐’๐ฅ๐ข๐ญ ๐‹๐š๐ฆ๐ฉ ๐„๐ฑ๐š๐ฆ๐ข๐ง๐š๐ญ๐ข๐จ๐ง:โฃ โฃ Diffuse corneal edema can be presentโฃ โฃ ๐ˆ๐ฆ๐š๐ ๐ข๐ง๐ :โฃ โฃ Anterior Segment OCT โฃ Ultrasound Biomicroscopy (UBM)โฃ โฃ ๐Œ๐š๐ง๐š๐ ๐ž๐ฆ๐ž๐ง๐ญ:โฃ โฃ โ— Conservative โ†’ Topical steroids, Hyperosmotic agentsโฃ โฃ โ— Surgical โ†’โฃ a. Internal Tamponade with airโฃ b. Descemetopexy with C3F8 and SF6โฃ c. Transcorneal suturingโฃ d. Descemetotomyโฃ e. Endothelial/ Penetrating Keratoplastyโฃ โฃ

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