Descemet's tear due to injector cartridge tip deformity

Abstract

Foldable intraocular lens (IOL) implantation using an injector system through 2.8-mm clear corneal incision following phacoemulsification provides excellent speedy postoperative recovery. In our reported case, a Sensar AR40e IOL (Abbott Medical Optics, USA) was loaded into Emerald C cartridge, outside the view of the operating microscope, by the first assistant. The surgeon proceeded with the IOL injection through a 2.8-mm clear corneal incision after uneventful phacoemulsification, immediately following which he noted a Descemet's tear with a rolled out flap of about 2 mm near the incision site. Gross downward beaking of the bevelled anterior end of the cartridge was subsequently noticed upon examination under the microscope. We suggest careful preoperative microscopic inspection of all instruments and devices entering the patient's eyes to ensure maximum safety to the patient.

Figure 1

Downward beaking of the beveled anterior end of the Emerald C Cartridge (Lot CH00841 of Advanced Medical Optics, Inc., USA)

Figure 2

A small rolled out Descemet's flap and adjacent Descemet's striae (left eye of the reported case on the first postoperative day)

Figure 3

Corneal opacity at the deeper corneal layers with mild surrounding edema (left eye of the reported case at 4 weeks post-op)