PURPOSE: To report an unusual complication of treatment in the case of a Descemet's membrane detachment. METHODS: Observational case report. RESULTS: A 79-year-old woman presented for elective cataract surgery. Ocular risk factors identified preoperatively included moderately shallow anterior chambers bilaterally, previously treated with bilateral YAG peripheral iridotomies. After a clear corneal section during phacoemulsification, large Descemet's tears on introducing the micro finger and phaco probe were noticed. Conversion to an extracapsular technique was necessary because of poor view. Similar peroperative Descemet's detachments were noticed in the contralateral eye during phacoemulsification by a senior surgeon a year later. Postoperatively, the Descemet's detachments were managed by intracameral SF6 and later C3F8 gas. A few weeks later, a fine haze was noticed under the anterior surface of the intraocular lens (IOL). Corneal edema persisted and corneal decompensation ensued. Both eyes needed penetrating keratoplasties. The right eye needed an IOL exchange due to IOL haze. CONCLUSIONS: In this case the SF6 or C3F8 gas may have produced the unexpected effect of an anterior IOL haze. The mechanism of this phenomenon is unknown. To the knowledge of the authors, this effect has not been observed previously with SF6 or C3F8 gas. This haze was visually significant and required an IOL exchange. To the knowledge of the authors this is the first report of this nature. The authors advise caution when using intracameral SF6 or C3F8 gas for repair of Descemet's membrane detachment with this type of IOL.
PURPOSE: To report an unusual complication of treatment in the case of a Descemet's membrane detachment. METHODS: Observational case report. RESULTS: A 79-year-old woman presented for elective cataract surgery. Ocular risk factors identified preoperatively included moderately shallow anterior chambers bilaterally, previously treated with bilateral YAG peripheral iridotomies. After a clear corneal section during phacoemulsification, large Descemet's tears on introducing the micro finger and phaco probe were noticed. Conversion to an extracapsular technique was necessary because of poor view. Similar peroperative Descemet's detachments were noticed in the contralateral eye during phacoemulsification by a senior surgeon a year later. Postoperatively, the Descemet's detachments were managed by intracameral SF6 and later C3F8 gas. A few weeks later, a fine haze was noticed under the anterior surface of the intraocular lens (IOL). Corneal edema persisted and corneal decompensation ensued. Both eyes needed penetrating keratoplasties. The right eye needed an IOL exchange due to IOL haze. CONCLUSIONS: In this case the SF6 or C3F8 gas may have produced the unexpected effect of an anterior IOL haze. The mechanism of this phenomenon is unknown. To the knowledge of the authors, this effect has not been observed previously with SF6 or C3F8 gas. This haze was visually significant and required an IOL exchange. To the knowledge of the authors this is the first report of this nature. The authors advise caution when using intracameral SF6 or C3F8 gas for repair of Descemet's membrane detachment with this type of IOL.
Authors: Arie L Marcovich; Tamer Tandogan; Mor Bareket; Eva Eting; Ifat Kaplan-Ashiri; Amir Bukelman; Gerd U Auffarth; Ramin Khoramnia Journal: BMJ Open Ophthalmol Date: 2018-12-15