posterior capsular rupture
TRANSCRIPT
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POSTERIOR CAPSULAR
RUPTUREDr.Prathibha.M.C
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RECOGNITION OF RISK FACTORS FOR PC
RUPTURE
Patient factor Surgeon factorType ofcataract
Associatedfactor withcataract
Compliant eye
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PATIENT FACTOR
Deep set eyes
Inability of the patient to lay supine
Short neck
COPD
Cor pulmonale
Obesity
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SURGEON FACTOR
During training..during transition to learn
new techniques
Topical anesthesialearning curve
Aggressive and inappropriate phaco parameters
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TYPE OF CATARACT
Pre existing posterior capsule defect- congenital;
traumatic
Posterior lenticonus
Hard cataract White mature cataract
Cataract following VR surgery
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ASSOCIATED FACTORS
PxF
Small pupil
Subluxated cataract
Previous trauma
Zonular weakness with systemic disorder
Increased AxL with deep anterior chamber
Shallow AC
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COMPLIANT EYES
High myopia
Post vitrectomy
Trauma
Inflammaation
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PATHOGENESIS OF PCR
Discontinuity in therhexis margin
Vigorous hydrodissection
Mechanical traumaduring dialing the nucleus
Sculpting nuclear divisionand fragmentremoval..sudden occlusionbreak response
Irrigation and aspiration
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IDENTIFICATION AT DIFFERENT STAGES
Pupil snap sign
Deepening of AC, loss of counter resistance
during sculpting
Inability to occlude..sinking nucleus Loss of followability
Inability to aspirate corticl matter
Unstable IOLvertical tilt
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PREVENTION
Pre-operative evaluation
Couselling
Surgical manuevers
Reducing the AFR, Vacuum,U/S in stepwisemanner prevents sudden occlusion break
response
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MANAGEMENT OF PCR
PCR with intact anterior hyaloid face during
emulsification
Stop all the movements of the probe.dont
remove the probe Inject viscoelastic---to tamponade through side
portgently remove the probe
Elevate the lens from the area of rentdelineate
the extent of rent Well defined small rentcontinue with low
FR,high vacuum with reuced bottle height,high
U/s
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PCR WITHVL
Vitrectomy- high cut rtae .low vacuum.low
Frwith minimal bottle height
Adequte vitrectomy. Round regular
pupil..sweep with iris spatula over the pupil alsoin the wound
Main incision and side port sutured with 10-O
nylon
Intracameral Pilocarpine 1ml +1%vancomycin0.1 ml is injected
Contriction of pupil is inducative of absence of
vitreous in AC
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During sculpting
During division
During fragment removal
During I/A
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IOL FIXATION
Extent of PCRintegrity of capsule
Small rent- in bag .< than optic size of IOL
Sulcus
ACIOL
Secondary IOL placement
Sclera fixated
Iris fixated