When we make a phaco incision that involves the cornea, there is always a risk of having focal detachment of Descemet's membrane. This happens due to incision architecture, bringing instruments in/out of the incision, and due to the patient's anatomy and tissue response. When this happens, we can detect it by looking carefully at the incision site.
The OCT imaging shows the presence of a focal detachment in Descemet's membrane at the incision site. This small defect can be addressed by inflating the eye with balanced salt solution which should push this flap back into position. The the endothelial pump function will keep the flap adherent to the corneal stroma. For larger defects, injecting an air bubble can help provide further support to keep Descemet's membrane in position. The air bubble can be 100% room air or a combination of air plus a small amount of SF6 gas (such as 16% SF6 with 84% room air by using 0.5cc of SF6 with 2.5cc of room air).
