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Height-, extent-, length-, and pupil-based (HELP) algorithm to manage post-phacoemulsification Descemet membrane

Dhivya Ashok Kumar1, Amar Agarwal1, Soundari Sivanganam1

  • 1From Dr. Agarwal's Eye Hospital and Eye Research Centre, Chennai, India.

Journal of Cataract and Refractive Surgery
|November 26, 2015
PubMed
Summary

This study shows that the HELP protocol effectively manages Descemet membrane detachment after cataract surgery. Early surgical intervention for central detachments can prevent vision loss from scarring.

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Area of Science:

  • Ophthalmology
  • Corneal Surgery
  • Anatomic and Functional Outcomes

Background:

  • Descemet membrane detachment can occur after phacoemulsification (cataract surgery).
  • Management strategies vary, impacting visual outcomes.

Purpose of the Study:

  • To evaluate the functional and anatomic outcomes of a protocol for managing Descemet membrane detachment post-phacoemulsification.
  • The protocol (HELP) bases treatment on detachment height, extent, chord length, and pupillary relation.

Main Methods:

  • A prospective comparative case series of 161 eyes with post-phacoemulsification Descemet membrane detachment.
  • Eyes were managed surgically or medically using the HELP protocol.
  • Anterior segment optical coherence tomography (AS-OCT) assessed central corneal thickness (CCT), chord length, and detachment height.

Main Results:

  • 96 eyes (Group 1) were treated surgically, 65 (Group 2) medically.
  • Complete reattachment rates were high in both groups (95.8% vs. 96.9%).
  • Corrected distance visual acuity (CDVA) of 20/40 or better was achieved in 83.3% (Group 1) and 92.3% (Group 2); no significant difference in final CDVA between groups.

Conclusions:

  • The AS-OCT-based HELP protocol is effective for managing post-surgical Descemet membrane detachment, especially in dense corneal edema.
  • Prompt surgical intervention for central detachments minimizes visual impairment due to scarring.