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Combined clear corneal phacoemulsification and transpupillary removal of silicone oil. Y ü ksel Totan , Ramazan Ya ĝ c ı , Zeynel Arslany ı lmaz , U ĝ urcan Keskin The authors have no financial interest. Introduction.
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Combined clear corneal phacoemulsification and transpupillary removal of silicone oil Yüksel Totan, Ramazan Yaĝcı, Zeynel Arslanyılmaz, Uĝurcan Keskin Theauthorshave no financialinterest
Introduction • Cataract is a frequentcomplication of siliconeoiltamponadeusedin themanagement of proliferativevitreoretinopathyandadvanceddiabeticretinopathycomplications. • Weaimed to evaluate clinical results of clear corneal phacoemulsification combined with transpupillarysilicone oil removal.
Patients and methods • A retrospectivestudy • 20 patients; 13 males, 7 females • Agerange; 14-75 years, meanage 53 yrs • Thesamesurgeon(YT) performedalltheoperations. • Thereasonsforprimaryvitreoretinalsurgery: • Proliferativevitreoretinopathy in 13 eyes, • Retinaldetachmentwithgianttear in 2 eyes • Retinaldetachmentwithmacular hole in 1 eye, • Proliferativediabeticretinopathycomplications in 4 eyes.
Patients and methods • Type of cataract • Posteriorsubcapsularopacitiescombinedwithnuclearsclerosis • Biometry • SRK/T formulausingtrueaxiallength(AL) • True AL wasestimatedbymultiplyingmeasured AL bytheconversionfactor of 0.71 • Type of anesthesia • Topical (10 eyes), • Peribulbar (9 eyes), • General anesthesia (1 eye-14 yearsold)
Patients and methods • Surgicalsteps; • A superiorclearcornealincision • Phacoemulsification (quickchoptechnique) • Anteriorchambermaintainerplacementforinfusion • Posteriorcapsulotomy • Siliconeoilremovalthroughtheposteriorcapsulotomywith a 16 gaugecannulaconnectedto a 10 mL syringe • Retinalexaminationwith a wide-angleviewingsystem • IOL implantation in thecapsularbagorsulcus.
Results Visualacuity(BCVA) Aftervitreoretinalsurgery: Handmotion in 2 eyes, Fingercounting in 5 eyes, 0.05 to0.7 (Snellenschart) in 13 eyes Aftercombinedphacoemulsificationplussilicone oil removal Fingercounting in 3 eyes, 0.1 to1.0 (Snellenschart) in 17 eyes “Mean BCVA increase is 2 Snellenslines”
Results Opticalcorrection: IOL implantation in 18 eyes, 2 eyesleftaphakicaccordingtothepreopbiometry Typeof IOL implantation: Capsularbag in 12 eyes Ciliarysulcus in 6 eyes. IOL type HydrophilicacrylicmonoblocIOL in 14 eyes, HydrophobicacrylicmonoblocIOL in 4 eyes
Results Follow-upperiod: Mean, 12 months(range, 4-36 months) Postoperativerefractiveerror (sphericalequivalent): Themeandeviation,-1.0 ± 1.84 D (range, +2.0 to-5.0 D) A total of 90% waswithin± 2 D 45% had a deviation of ± 1 D “No significantsurgicalcomplicationleadingtodecreasedvisionwasencounteredduringthefollow-upperiod”.
Discussion Cataract is a commoncomplicationfollowingvitreoretinalsurgerywithsiliconeoiltamponade. Combinedphacoemulsificationandsiliconeoilremovalthrough a clearcornealincision has someadvantages : Reducednumber of surgicalprocedures, Reducedoperation time, Lessor no posteriorpressureduringphacoemulsificaiton, No sclerotomy, No posteriorcapsularopacification, Reduced risk of retinaldetachmentandvitreoushemorrhage (Because ora serrata is spared)
Discussion Somepotentialdisadvantages of combinedsurgery: Lesspredictablepostoperativerefraction, Increaseddifficulty of in-thebagIOL implantation (particularlyfor mono-blochydrophilicIOLs), Relativehypotonyaftersiliconeoilremoval, No chance of membranepeelingorretinalstabilization. Potentialsubluxation of the IOL in case of inadvertentlargeposteriorcapsulotomy Angiographicmacularedema
Conclusion Combinedphacoemulsificationandsiliconeoilremovalthrough a clearcornealincision is a safeandeffectivetechnique, but must be reservedin selectedcases in which retina is permanentlystabilizedwith no significantepiretinalorsubretinalmembranes.