Type Causal elements Management
Rhegmatogenous Hole, tear, dialysis Small, clinically insignificant: Observation Clinically significant: Pneumodescemetopexy + Supradescemetic fluid drainage + Post-op positioning
Tractional - Incarceration in: synechiae, wound, suture, graft-host junction - Long standing RDD adhering to intraocular contents with contraction Small, clinically insignificant: Observation Clinically significant: - Healthy endothelium – Relaxing descemetotomy + Pneumodescemetopexy + Supra-descemetic fluid drainage + Post-op positioning - Unhealthy endothelium – Penetrating or endothelial keratoplasty
Bullous Viscoseparation, trapped blood, infection, inflammation, Anwar's big bubble, trauma Intraoperative nick or YAG Descemetopuncture, according to cause
Complex Poorly repositioned DD: - DMEK graft post-op re-detachments - Long standing RDD with fibrosis combinations Observation, refloation, endothelial or penetrating keratoplasty