Central retinal artery occlusion after Descemet membrane reposition by intracameral air: A case report

Meena, Ashok Kumar; Ghodke, Bhushan; Parmar, Gautam Singh

doi:10.1177/1120672119870740

Cited by 3 publications

(5 citation statements)

References 16 publications

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“…It was performed using a 30-gauge syringe at the slit lamp without a side port blade [ 9 ], allowing a minimally invasive incision with probably faster recovery time. Furthermore, no partial air release was needed in our patients to avoid severe complications such as central retinal artery occlusion compared with previous studies [ 4 ]. Additionally, drainage of predescemetic fluid by stab incision on the cornea was not necessary to achieve DM attachment as previously performed in other studies [ 10 ], making this procedure quicker and easier.…”

Section: Discussionmentioning

confidence: 91%

“…Researchers have demonstrated that 100% air descemetopexy is more effective than iso-expansile gases, with 95% success in the reattachment of DM and statistical improvement in visual acuity [ 3 ]. Nonetheless, rarely, central retinal artery occlusion occurs after full-chamber air bubble injection [ 4 ]. To reduce the adverse effects following air descemetopexy, partial air release was applied after complete air filling for a certain period [ 5 , 6 ].…”

Section: Introductionmentioning

confidence: 99%

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A Simple Repair Algorithm for Descemet’s Membrane Detachment Performed at the Slit Lamp

Zhu

Fan

et al. 2022

JCM

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Our study aims to investigate a simple repair algorithm for Descemet’s membrane detachment (DMD) following phacoemulsification with Pentacam and anterior segment optical coherence tomography (AS-OCT). Twelve patients with DMD were included in this retrospective study. All cases had persistent corneal edema after phacoemulsification and no improved response to conservative treatment. The repair algorithm consisted of delineating the DMD with the Pentacam and AS-OCT, paracentesis, and intracameral air bubble performed at the slit lamp, followed by immediate supine position. At one month, the final status of Descemet’s membrane (DM), best-corrected visual acuity, and incidence of complications were noted. DMD was involved in the visual axis in all cases. The mean interval between phacoemulsification and repair was 5.3 ± 1.2 days. Complete reattachment of DM and corneal clarity occurred in all 12 eyes. Eleven (91.7%) eyes underwent one repair procedure, while one eye (8.3%) underwent a repeat procedure. No adverse events were found. Minor post-intervention complications included temporary increased intraocular pressure due to pupillary block in one eye (8.3%). In conclusion, our modified and simplified repair algorithm for DMD can be performed safely as an outpatient procedure, with accurate delineation using a Pentacam and AS-OCT. It may provide new insight into the timely diagnosis, evaluation, and management of DMD.

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Section: Discussionmentioning

confidence: 91%

Section: Introductionmentioning

confidence: 99%

A Simple Repair Algorithm for Descemet’s Membrane Detachment Performed at the Slit Lamp

Zhu

Fan

et al. 2022

JCM

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“…There was one case of CRAO reported on a healthy 60-year-old patient following pneumatic Descemetopexy (Descemet membrane reposition by intracameral air) after cataract surgery one day earlier. 50 The intracameral air bubble was partially released after 2 h. There were no reported signs of raised IOP (e.g. headache, eye pain, nausea or vomiting) during the immediate postoperative period.…”

Section: Mechanismsmentioning

confidence: 83%

“…RAO appeared to be unrelated to the type of regional block: the reported cases occurred in relation to retrobulbar blocks (40/97, 41%) 5,7,13,14,18 –33 (Supplementary Table 1), peribulbar blocks (36/97, 37%) 27,32,34 –42 (Supplementary Table 2), sub-Tenon’s blocks (19/97, 20%) 16,32,39,43 –49 (Supplementary Table 3), one topical local anaesthetic (1/97, 1%) 50 and one unknown local anaesthetic technique (1/97, 1%), 51 which contained no anaesthetic details.…”

Section: Retinal Artery Occlusion After Ophthalmic Surgery Under Regi...mentioning

confidence: 99%

Retinal artery occlusion after ophthalmic surgery under regional anaesthesia: A narrative review

Chua,

Harrisberg

et al. 2023

Anaesth Intensive Care

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Two recent cases of central retinal artery occlusion under otherwise uncomplicated sub-Tenon’s block that resulted in significant visual loss after cataract surgery prompted us to undertake a literature review of such cases. We identified 97 cases of retinal artery occlusion after ophthalmic surgery under regional anaesthesia that had no immediate signs of block-related complications. These occurred after various intraocular (87%) and extraocular (13%) operations, across a wide range of ages (19–89 years) on patients with (59%) or without (39%) known risk factors. The anaesthetic techniques included 40 retrobulbar blocks, 36 peribulbar blocks, 19 sub-Tenon’s blocks, one topical anaesthetic and one unspecified local anaesthetic. Different strengths of lidocaine, bupivacaine, mepivacaine and ropivacaine, either alone or in various combinations, were used. The details of the anaesthetic techniques were often incomplete in the reports, which made comparison and analysis difficult. Only nine cases had their cause (optic nerve sheath injury) identified, while the mechanism of injury was unclear in the remaining patients. Various mechanisms were postulated; however, the cause was likely to be multifactorial due to patient, surgical and anaesthetic risk factors, especially in those with compromised retinal circulation. As there were no definite risk factors identified, no specific recommendations could be made to avoid this devastating outcome. We have provided rationales for some general considerations, which may reduce this risk, and propose anaesthetic options for ophthalmic surgery on the fellow eye if required, based both on our literature review and our personal experience.

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“…Compared with 100% sterile air, longer acting gas mixtures have better stability and retention times [15,16], which may lead to better outcomes. However, longer acting gas mixtures had a higher risk for endothelial toxicity and a pupillary block even central retinal artery occlusion (CRAO) or branch retinal arterial occlusion (BRAO) [29]. To date, the success rates of descemetopexy with longer acting gas mixtures have been reported to range from 71.64-95% [16,30].…”

Section: The Modi Ed Descemetopexymentioning

confidence: 99%

Newly Modified Descemetopexy Method in Descemet’s Membrane Detachment and Prognostic Analysis: A Systematic Review

Shen¹,

Peng²,

Xiao³

et al. 2020

Preprint

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BackgroundTo present a newly modified descemetopexy method and investigate the most determinative factor in the prognosis of Descemet’s membrane detachment (DMD). MethodsThis was a retrospective review of 37 patients (38 eyes) treated with the newly modified descemetopexy method. This surgical method was combined with the vacuum technique to pump supra-Descemet’s fluid. After reviewing and screening, we enrolled 31 patients (32eyes). We evaluated outcomes using the anatomical reattachment of DM [anatomical success (AS)] and the resolution of corneal oedema [functional success (FS)]. Donor characteristics, including sex, age, the presence of diabetes, ocular history, DMD duration, DMD grade, were analysed. Patients were divided into two groups according to whether FS was achieved. Univariate and multi-factor logistic regression analyses were adopted to evaluate factors contributing to the prognosis of DMD. ResultsAS was achieved in 31 eyes (96.9%), and FS was achieved in 21 eyes (65.6%). The univariate analysis showed that both the DMD grade (P=0.029) and DMD duration (P=0.004) affect the prognosis of DMD. The multiple logistic regression analysis indicated that the DMD duration was the dominant factor (P=0.006). No significant difference was found in the DMD grade, sex, age, presence of diabetes, presence of glaucoma or DMD-originating surgery between the two groups.ConclusionsDescemetopexy combined with the vacuum technique can be used to deal with DMD. The DMD duration is the dominant factor affecting the activity of endothelial cells and the final prognosis.

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Central retinal artery occlusion after Descemet membrane reposition by intracameral air: A case report

Cited by 3 publications

References 16 publications

A Simple Repair Algorithm for Descemet’s Membrane Detachment Performed at the Slit Lamp

A Simple Repair Algorithm for Descemet’s Membrane Detachment Performed at the Slit Lamp

Retinal artery occlusion after ophthalmic surgery under regional anaesthesia: A narrative review

Newly Modified Descemetopexy Method in Descemet’s Membrane Detachment and Prognostic Analysis: A Systematic Review

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