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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.
Insights
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.
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.
Purpose:
To analyze the functional and anatomic outcomes of management of Descemet membrane detachment after phacoemulsification using a protocol based on the detachment's height, extent, and chord length and its relation to the pupil.
Setting:
Dr. Agarwal's Eye Hospital and Eye Research Centre, Chennai, India.
Design:
Prospective comparative case series.
Methods:
Eyes with post-phacoemulsification Descemet membrane detachment were managed surgically or medically based on the detachment's height, extent, length (chord), and relation to the pupil (HELP protocol). Central corneal thickness (CCT), chord length, and detachment height were determined by anterior segment optical coherence tomography (AS-OCT) (Visante).
Results:
Of 161 eyes, 96 were treated surgically (Group 1) and 65 medically (Group 2). The mean length and mean height of Descemet membrane detachment were 2.4 mm ± 1.4 (SD) and 266 ± 189.8 μm, respectively, in Group 1 and 1.03 ± 0.4 mm and 153.3 ± 60.8 μm, respectively, in Group 2. The complete reattachment rate was 95.8% in Group 1 and 96.9% in Group 2. The corrected distance visual acuity (CDVA) was 20/40 or better in 83.3% of eyes in Group 1 and 92.3% of eyes in Group 2. No eye lost CDVA as a result of a Descemet membrane scar in the central 5.0 mm of the cornea. The AS-OCT allowed visualization of the detachment in all eyes with a CCT of more than 800 μm. There was no difference in the final CDVA between Group 1 and Group 2.
Conclusions:
The AS-OCT-based algorithm was effective for managing post-surgical Descemet membrane detachment in eyes with dense corneal edema. Early surgical intervention for detachments in the central cornea can reduce scarring-induced visual loss.
Financial Disclosure:
No author has a financial or proprietary interest in any material or method mentioned.
