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VIDEO: How to manage conjunctival chemosis during cataract surgery
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By Anton Giulio Catania, MD, and Alessandro Galan, MD
With cataract surgery, the quality, or the devil, is in the details. How you place the corneal incisions with respect to the limbus can be by itself a decisive factor in determining the smooth conduct and overall success of the procedure. An incision performed at the conjunctival-limbal insertion may create access for the saline solution flowing out of the phacoemulsification or irrigation and aspiration handpieces, leading to conjunctival chemosis. If you do not manage this complication promptly, fluids may pool on top of the cornea, blocking visualization and making it difficult to insert the instruments into the eye.
Conjunctival chemosis can only be managed surgically. The most common way is by performing a full-thickness cut into the conjunctiva with scissors to make the accumulated fluids flow out.
In this video, we propose an alternative surgical maneuver, using the chopper without extracting the phacoemulsification or I&A handpieces from the corneal tunnel. The conjunctival tissue is hooked at the limbus in the exact point through which the fluid started seeping under the conjunctiva, opening it to allow drainage and prevent further accumulation. Acting fast is mandatory, from the early signs of conjunctival swelling. If performed in a timely manner, this is an effective and fast-acting maneuver that can be performed without interrupting the phacoemulsification procedure. The patient feels no pain, even when surgery is performed under topical anesthesia. Bleeding is extremely rare.
The conjunctiva heals quickly, and as soon as postoperative day 1, it is difficult to identify the site where the conjunctiva was opened.
Disclosures: The authors report no relevant financial disclosures.