Risk Factors for Descemet’s Membrane Detachment Following Small Incision Cataract Surgery NC01-NC03
Dr. Ajita Sasidharan,
Consultant, Department of Ophthalmology, Sankara Eye Hospital, Coimbatore-641035, Tamilnadu, India.
Introduction: Separation of Descemet's membrane and the endothelium from the stroma is called Descemet's detachment. The most common cause of Descemet’s Membrane Detachment (DMD) is mechanical separation near the incision site by an instrument, fluid or viscoelastic substance. DMD is an important vision threatening complication after cataract surgery.
Aim: To evaluate the risk factors for DMD following manual Small Incision Cataract Surgery (SICS).
Materials and Methods: A retrospective, non-comparative clinical analysis of the risk factors causing DMD was performed using computerised database. All cases operated for cataract extraction and intraocular lens implantation by manual SICS, in which only blade was used for construction of the sclera-corneal tunnel (incision, tunnel and entry)-no crescent and no keratome technique, under community outreach department between January 1st, 2013 and December 31st, 2013, were analysed. We analysed the preoperative, intraoperative and postoperative records of all the patients who suffered with a DMD. We compared the surgeon’s experience, ocular risk factors and the DMD.
Results: The mean age of patients having DMD was 64.89 years. Male to female ratio was found to be 0.54:1. The incidence of DMD was found to be 0.15% (57 patients out of 36,898). Dense cataract, shallow anterior chamber, Pseudoexfoliation (PXF), corneal opacities, steep cornea were found associated with DMD. Incidence of DMD was higher among final year trainees than the first year trainees. All DMDs were re-attached on first postoperative day.
Conclusion: DMD is a surgeon induced preventable cause for postoperative corneal oedema and low vision. Gentle instrumentation, early detection, judicious management may reduce the incidence and outcome of DMD especially in dense cataract, PXF, steep cornea and corneal opacities.