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Complications of SICS

Complications of SICS. Dr.Haripriya Aravind. Tunnel construction. Approach Placement Length Depth. Placement. Anterior incision Poor self sealing effect Wound leak Astigmatism Management: Suture. Posterior incision Wide tunnel Risk of bleeding Risk of premature entry

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Complications of SICS

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  1. Complications of SICS Dr.Haripriya Aravind

  2. Tunnel construction • Approach • Placement • Length • Depth

  3. Placement • Anterior incision Poor self sealing effect • Wound leak • Astigmatism Management: Suture

  4. Posterior incision • Wide tunnel • Risk of bleeding • Risk of premature entry Difficulty in nucleus delivery and instrument manipulation Management: Suture for premature entry

  5. Incision length • Short incision Difficulty in nucleus delivery Endothelial damage ris damage Management: Enlarge incision with keratome

  6. Long incision Poor approximation • Wound leak • Induced ATR astigmatism Management: Suture

  7. Incision Depth • Premature entry • Button holing • Scleral disinsertion

  8. Descemet’s Stripping • Main wound Instruments • Paracentesis VES/Fluids • Treatment • Air • Viscoelastics

  9. Paracentesis • Site • Size Too central Too peripheral Too small Too big

  10. Capsulotomy CAPSULORHEXIS • Peripheral extension/ Run away rhexis Post capsule tear Management • Reform AC with VES • Pull flap centrally • Cut capsule just ahead of peripherally extending rhexis • Continue in reverse direction • Canopener

  11. Inappropriate size • Too small Management: Enlarge the rhexis by 2 or 3 relaxing incisions • Too big

  12. Large rhexis Decenteration

  13. Hydrodissection • Incomplete hydro • Forceful hydro • PPC Complications • Inadequate cortical-capsular bag separation • Fluid misdirection syndrome • Zonular damage • Posterior capsular tear • Nucleus drop • Capsular block syndrome

  14. Nucleus prolapse Difficult situations • Incomplete hydroprocedure • Small rhexis • Mid-iris synechiae • Very soft nucleus • Hard brown wodden nucleus • Small pupil

  15. Complications • Endothelial Damage • Iridodialysis/Damage to Iris • Zonular Dialysis • PCR

  16. Nucleus Delivery • Endothelial damage • Zonular dialysis/PCR • Iris Sandwich

  17. Iris injury • Sphincter tear • Iridodialysis <1 hr : no intervention >1 hr : suture • Iris prolapse Careful repositioning Suture tunnel Post op steroids & NSAIDs

  18. Iridodialysis McCannel Suture

  19. Hyphema • From tunnel • Posterior tunnel • Deep tunnel • From Iris • Iris handling • Iridodialysis

  20. Intraoperative Miosis • Avoid iris touch • VES • Pharmacological • Spincterotomy • Hook

  21. Zonular dialysis Can be pre/intra operative • Approach • Bimanual prolapse of nucleus • Phacosandwich • IOL 1quad – sulcus (perpendicular to the dialysis) 2quad - CTR >2quad - ACIOL/aphakia

  22. Posterior capsular tear • Seal the tear using visco (don’t hydrate) • Automated ant vitrectomy • Residual cortex - dry aspiration Post op inflammation Obstruct visual axis Secondary glaucoma

  23. Bimanual automated vitrectomy At the start of vitrectimy Completed vitrectomy

  24. Dropped nucleus • If anterior : inject visco : deliver with vectis • Deep into the vitreous : Retinal surgeon intervention

  25. Expulsive Haemorrhage • Tissue prolapse • Hard globe • Loss of red glow • Choroidal haemorrhage • CRAO Rx : Suture IV Mannitol Post segment assessed

  26. Immediate post op complications Wound Dehiscence Etilology • Excessive episcleral cautrey • Premature entry • Button holing • Nuclear or cortical fragment in tunnel • Postoperative IOP rise • Collagen vascular diseases • Leaking paracentesis wound

  27. Treatment • Patch the eye • Cycloplegics • Exploration of wound and suturing

  28. Corneal complications • Corneal edema • Striate keratopathy • Bullous keratopathy

  29. Corneal complications Management : Control inflammation Antiglaucoma drugs Treat epithelial defect Cycloplegics

  30. Post op Iritis • Excess manipulation during nucleus prolapse & delivery • Residual cortex Management • Topical steroids & antibiotics • Cycloplegics • Topical NSAIDs

  31. Post op increase in IOP • Retained viscoelastics • Over distention of AC while reforming Rx: antiglaucoma medications

  32. Late complications • Corneal complications • Uveitis • Capsular bag complications • PCO • IOL malformations • CME • Endophthalmitis

  33. Post segment complications • RD • Lost lens syndrome • Vitreous hemorrhage • Vitritis

  34. Successful management • Recognition • Knowledge • Skill • Judgement

  35. THANK YOU

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