phaco in post- vitrectomy cataracts
DESCRIPTION
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 - PowerPoint PPT PresentationTRANSCRIPT
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Phaco in post-vitrectomy cataracts
George Kampougeris MD, MRCSEd, PhDConsultant Ophthalmic Surgeon
www.eyedoctorgk.gr
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DISCLOSURES
No financial interest in any of the products or techniques mentioned
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Post-vitrectomy cataractIncreased frequency of vitrectomiesPrevalence up to 80%, hence very frequentChildren-young adults: Posterior subcapsularAdults: NuclearLens touch with capsule break during vitrectomy:
usually rapid occurrence of total white cataract BE CAREFUL!
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SPECIAL PROBLEMSVery hard nuclear cataractSmall pupil Compromised zonules – iridophacodonesis !Posterior capsular plaques (very hard)Possible scleral buckles presentReduced visual potentialSilicone oil in the eye
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SPECIAL PROBLEMSANESTHESIA
Can be done with topical anesthetic only (drops) Intracameral lidocaine 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
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SPECIAL PROBLEMS – IOL
Hydrophobic or hydrophilic acrylic preferable (1- piece or 3- piece)PMMA (rigid)Large optic (at least 5.75mm), no plate haptic
designNo silicone IOLsBeware of IOL calculation when silicone oil present !
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SPECIAL PROBLEMS - SURGERYHypotony (use lots of viscoelastics)Very deep A/C (low bottle height, low infusion, low
zoom at microscope)Careful incision (2 or 3-step)Small pupil (iris hooks, Malyugin ring)
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SPECIAL PROBLEMS - SURGERY
Capsulorhexis - anterior capsular fibrosis- poor red reflexUse vision blue - no small rhexis (larger than 5-5.5mm)Hydrodissection: Slow-carefulCAREFUL: When in doubt about posterior capsule integrity (white cataract) – hydrodelineation only! (or viscodissection)
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SPECIAL PROBLEMS - SURGERYPhaco (most cases straightforward)Preferable to use a technique with fewer manipulations(phaco chop, stop and chop)Excessive fluctuations of anterior chamber depthlow bottle height, keep irrigation goingInfusion deviation syndrome (when fluid escapes
backwards through defective zonules, shallow A/C)raise the iris
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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?)
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POSTOPERATIVE CAREAvoid 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)
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CONCLUSIONSPlan your surgery in advance Have accessory equipment available (sulcus
IOLs, Malyugin rings, iris hooks, CTR, viscoelastics)
Even for experienced surgeons: SLOWLY-CAREFULLY