Incidence of incision site descemet membrane detachment after phacoemulsification done by residents versus professional staff

Abstract

Objective To compare the incidence of Descemet membrane detachment (DMD) following phacoemulsification by residents and professional staff and correlate its anatomical and functional outcomes with surgical variables, such as effective phaco time, surgical time, and size of keratome used. Patients and methods A prospective study included 250 eyes with senile cataract undergoing phacoemulsification, which were stratified according to surgeon experience into two groups during the period from October 2022 to 2023. Postoperative assessment included best-corrected visual acuity, slit lamp examination to detect DMD, document its incidence and extent of corneal edema, and anterior segment optical coherence tomography for all eyes. These assessments were completed first day, 3, and 6 weeks after surgery. Results 114 out of 250 eyes had DMD detected by anterior segment optical coherence tomography representing an incidence rate of 64.8% in the residents’ group and 25.4% in the professional staff group. Risk factors for DMD were present more in the residents’ group, most notably effective phaco time greater than 10 s, surgical time greater than 44 min, advanced age of the patient, more with 2.2 mm keratome size and greater than 3 times of entry in anterior chamber with the phaco tip. Postoperative complications were notably higher in the residents’ group, with 10.9% requiring further intervention versus 0% in the professional staff group. Conclusion The study highlights the importance of incision size and surgical experience in managing DMD and its impact on postoperative corneal health. Optimizing handpiece design and considering mechanical enlargement of the incision before lens implantation may reduce the incidence of DMD.