Management of Postoperative Descemets Membrane Detachment

1
Management of Post-operative Descemets Membrane
Detachment
Dr. B. Shobana Dr. Mohan Rajan Dr. Sujatha
Mohan Dr. Manoj Khatri Rajan Eye Care Hospital,
Chennai-17 A Super speciality Eye Hospital
Post-Graduate Institute of Ophthalmology (Affili
ated to National Board of Examinations, New
Delhi) AN ISO 90012000
2
Materials and Methods 6 months -Jul 2005 to Dec
2005
Aim of the study
To evaluate the outcomes of 10 eyes of 10
patients referred to our hospital for management
of post-operative Descemets membrane detachment
using different techniques
Time of presentation
Type of surgery

• Immediate post-op 2 pts
• lt 2 weeks 6 pts
• 2 - 4 weeks 2 pts

• ECCE 3
• SICS 5
• PHACO 2

3
Work-up

• Visual acuity
• Slit-lamp examination
• Localised Corneal edema
• Extent of detachment- clear line of demarcation
• AC reaction
• AC depth
• Intraocular pressure
• Fundus examination

4
Post air injection - CLEAR CORNEA
DM DETACHMENT
DM DETACHMENT
Post air injection with suturing - CLEAR CORNEA
5
Management (Performed by a Single Surgeon)
6
DM DETACHMENT
LIMBAL STAB WOUND
SODIUM HYALURONATE INJECTION
7
Post-op positioning

• Patient maintained in Supine position on the
  operation table for 1 hour before being shifted
  to ward
• Supine position maintained for 24 hrs without
  pillow

Post op medication

• Topical Cycloplegics (to prevent pupillary block)
• Topical Antibiotic/steroid

• Anti-glaucoma medication

8
Results

• AC well-formed 10 pts

• Clear cornea 10 pts
• Elevated IOP 8 pts (managed effectively with
  anti-glaucoma measures)
• Post-operative visual acuity (Improved to
  20/40-20/20)10pts

Conclusion

• Descemets membrane detachment can lead to
  hazardous effects on the cornea leading to
  corneal edema and decompensation with poor visual
  acuity
• In our experience, simple and timely intervention
  such as air injection has been proven to give
  excellent improvement in visual outcome.