1 / 12

Phaco in post- vitrectomy cataracts

Phaco in post- vitrectomy cataracts. George Kampougeris MD , MRCSEd , PhD Consultant Ophthalmic Surgeon www.eyedoctorgk.gr. DISCLOSURES. No financial interest in any of the products or techniques mentioned. Post- vitrectomy cataract. Increased frequency of vitrectomies

nay
Download Presentation

Phaco in post- vitrectomy cataracts

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Phaco in post-vitrectomy cataracts George Kampougeris MD, MRCSEd, PhD Consultant Ophthalmic Surgeon www.eyedoctorgk.gr

  2. DISCLOSURES No financial interest in any of the products or techniques mentioned

  3. Post-vitrectomy cataract • Increased frequency of vitrectomies • Prevalence up to 80%, hence very frequent • Children-young adults: Posterior subcapsular • Adults: Nuclear • Lens touch with capsule break during vitrectomy: usually rapid occurrence of total white cataract BE CAREFUL!

  4. SPECIAL PROBLEMS • Very hard nuclear cataract • Small pupil • Compromised zonules– iridophacodonesis ! • Posterior capsular plaques (very hard) • Possible scleral buckles present • Reduced visual potential • Silicone oil in the eye

  5. SPECIAL PROBLEMS ANESTHESIA • Can be done with topical anesthetic only (drops) Intracamerallidocaine suggested • Peribulbar or subtenon’s: Preferable by many when surgery is anticipated to be long (very hard cataract, zonular instability, small pupil) • General anesthesia if possible can be a good option

  6. SPECIAL PROBLEMS –IOL • Hydrophobic or hydrophilic acrylic preferable (1- piece or3- piece) • PMMA (rigid) • Large optic (at least 5.75mm), no plate haptic design • No silicone IOLs Beware of IOL calculation when silicone oil present !

  7. SPECIAL PROBLEMS - SURGERY • Hypotony (use lots of viscoelastics) • Very deep A/C (low bottle height, low infusion, low zoom at microscope) • Careful incision (2 or3-step) • Small pupil (iris hooks, Malyugin ring)

  8. SPECIAL PROBLEMS - SURGERY • Capsulorhexis • anterior capsular fibrosis • poor red reflex Use vision blue - no small rhexis (larger than 5-5.5mm) • Hydrodissection: Slow-careful CAREFUL: When in doubt about posterior capsule integrity (white cataract) – hydrodelineationonly! (or viscodissection)

  9. SPECIAL PROBLEMS - SURGERY • Phaco (most cases straightforward) Preferable to use a technique with fewer manipulations (phaco chop, stop and chop) • Excessive fluctuations of anterior chamber depth low bottle height, keep irrigation going • Infusion deviation syndrome (when fluid escapes backwards through defective zonules, shallow A/C) raise the iris

  10. SPECIAL PROBLEMS – SURGERY • Posterior capsular plaques (fibrotic tissue) especially when silicone oil was used:posterior capsulorhexis • Careful when inserting IOL (in zonular instability use CTR-capsular tension ring) • Avoid hypotony at the end (suture?)

  11. POSTOPERATIVE CARE • Avoid excessive inflammation (steroids, NSAIDs, cycloplegics) • Increased incidence of posterior synechiae and cystoid macular edema • Increased frequency of follow-ups (also consider that many patients are diabetics)

  12. CONCLUSIONS • Plan your surgery in advance • Have accessory equipment available (sulcus IOLs, Malyugin rings, iris hooks, CTR, viscoelastics) • Even for experienced surgeons: SLOWLY-CAREFULLY

More Related