Dr. Himanshu Shekhar, S13008, Dr. Ajoy Virdi, Dr. Lalit Kumar Tejwani, Dr. Reetika
Purpose: To see the feasibility and success of a simple technique of injection of intracameral gas for postoperative DMD, using Sodium hyaluronate as sealant.
Method: The study was performed in eleven eyes of 11 patients with postoperative DMD. Intracameral injection of 14% C3F8 gas was planned. A small paracentesis was made at the limbus with a microvitreoretinal blade. A small amount of aqueous was let to drain. A cannula was introduced into the anterior chamber through this paracentesis. The C3F8 gas was injected into the anterior chamber under the detached descemet’s. Sodium hyaluronate 1% was injected over the paracentesis and the cannula was withdrawn.
Result: The gas could be injected in all the eyes by a single attempt. There was no egress of gas during or after withdrawal of the cannula.
Conclusion: This technique of use of sodium hyaluronate allows the retention of the gas and blocks the port nicely during removal of the cannula. Multiple attempts to retain the gas inside the anterior chamber is avoided.
Key-words: Descemet’s detachment, sodium hyaluronate, intracameral.
Introduction:
Descemet’s membrane detachment (DMD) is relatively common, occurring in up to 43%of cataract surgeries[1]. Most of these are small and peripheral at incision site and don’t require treatment. Only 0.5% are large and involve the central cornea[2] and up to 8% of these subsequently require a corneal transplant to regain corneal clarity [3-4].
Management options for significant detachments include air tamponade, SF6, C3F8 tamponade, transcorneal suture, intracameral viscoelastic gel, etc. Egress of air while withdrawing the canula remains a problem in achieving significant concentration of air in anterior chamber. We describe a simple modification in technique using sodiul hyaluronate as a sealant. The purpose of the study was to see the feasibility and success of a simple technique of injection of intracameral gas for postoperative DMD, using Sodium hyaluronate as sealant.
Methods:
The study was performed in eleven eyes of 11 patients with postoperative descemet’s detachment. Small, peripheral and insignificant detachments were not included in the study. Intracameral injection of 14% C3F8 gas was planned. A small paracentesis was made at the limbus with a microvitreoretinal blade. A small amount of aqueous was drained out. A cannula was introduced into the anterior chamber through this paracentesis. The C3F8 gas was injected into the anterior chamber under the detached descemet’s. Sodium hyaluronate 1% was injected over the paracentesis and the cannula was withdrawn.
Results:
The gas could be injected in all the eyes by a single attempt. There was no eggress of gas during or after withdrawl of the cannula. In the postoperative period the descemet’s membrane was well attached in all the eyes except one eye in which there was some residual inferior descemet’s detachment. A re-injection was done in this eye and the descemet’s was well attached the next day.
Discussion:
Intracameral air or gas injection is a very successful method for reattachment of descemets detachments. Egress of air while withdrawing the canula leads to decrease concentration of air and this may require multiple injections. Our technique of use of sodium hyaluronate allows the retention of the gas and blocks the port nicely during removal of the cannula. Multiple attempts to retain the gas inside the anterior chamber is avoided increasing the success rate of the procedure.
References:
- Monroe WM. Gonioscopy after cataract extraction. South Med J 1971;64 (9):1122-1124.
- Khng CY, Voon LW, Yeo KT. Causes and management of Descemet’s membrane detachment associated with cataract surgery-not always a benign problem. Ann Acad Med Singap 2001;30(5):532-535.
- Walland MJ, Stevens JD, Steele AD. J Cataract Refract Surg Repair of Descemet’s membranedetachment after intraocular surgery. 1995;21(3): 250-253.
- Krachmer JH, Mannis MJ, Holland EJ , Cornea 3rd ed. Mosby: St. Louis, Mo; 2011.
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