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Aiello F, Rampat R, Gallo Afflitto G, Din N, Mandal N, Maurino V. Zonular dialysis and cataract surgery: results from a UK tertiary eye care referral centre. CANADIAN JOURNAL OF OPHTHALMOLOGY 2024; 59:67-72. [PMID: 36627103 DOI: 10.1016/j.jcjo.2022.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/27/2022] [Revised: 11/27/2022] [Accepted: 12/08/2022] [Indexed: 01/08/2023]
Abstract
OBJECTIVE Zonular dialysis (ZD), referred to as the presence of a deficient zonular support for the lenticular capsule, might be the result of several causes and be detected only at the time of cataract surgery. The aim of this study was to evaluate pre-, intra-, and postoperative features of eyes with ZD regardless of the etiology detected during cataract surgery. METHODS A single-centre retrospective observational cohort study was performed at Moorfields Eye Hospital (NHS Foundation Trust, London, U.K.) to identify patients who underwent cataract surgery whose procedure was intraoperatively described as being complicated by ZD between January 1, 2014, and August 22, 2019. Patient characteristics, intraoperative clinical findings, visual and refractive outcomes, and postoperative complications were recorded. RESULTS ZD was identified intraoperatively in 447 eyes. In most cases (213 of 223; 96.8%), patients underwent a phacoemulsification procedure, not requiring any conversion to intracapsular or extracapsular extraction technique. Intraoperative complications increased to 46.2% (103 of 223), with no significant correlation with ZD width. Capsular tension rings (CTRs) were implanted in 43.4% of patients (97 of 223). The use of CTRs correlated with better postoperative visual and refractive outcomes. CONCLUSIONS ZD is a serious complication of cataract surgery requiring prompt intraoperative diagnosis and proper management. While it tends to worsen cataract surgery outcomes, the implantation of CTRs during the surgical procedure seems to be associated with better postoperative visual and refractive results.
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Affiliation(s)
- Francesco Aiello
- Ophthalmology Unit, Department of Experimental Medicine, University of Rome "Tor Vergata," Rome, Italy.
| | - Radhika Rampat
- Moorfields Eye Hospital NHS Foundation Trust, London, United Kingdom
| | - Gabriele Gallo Afflitto
- Ophthalmology Unit, Department of Experimental Medicine, University of Rome "Tor Vergata," Rome, Italy; Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL
| | - Nizar Din
- Moorfields Eye Hospital NHS Foundation Trust, London, United Kingdom
| | - Niraj Mandal
- Moorfields Eye Hospital NHS Foundation Trust, London, United Kingdom
| | - Vincenzo Maurino
- Moorfields Eye Hospital NHS Foundation Trust, London, United Kingdom
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Intrastromal cannula injury in cataract surgery. J Cataract Refract Surg 2020; 46:e52-e53. [PMID: 32947384 DOI: 10.1097/j.jcrs.0000000000000438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Iatrogenic ocular injuries from unexpected cannula ejection during ophthalmic surgery are rare and can cause vision-threatening damage. This report describes 2 cases of cannula-associated ocular injuries that resulted in good visual outcome, despite the cannula traveling intrastromally through the visual axis.
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V Tran T, Mansouri K, Mermoud A. Goniowash: a new surgical approach combined with cataract surgery to lower intraocular pressure in pseudoexfoliation syndrome. Int Ophthalmol 2020; 41:1563-1571. [PMID: 32592126 PMCID: PMC8087560 DOI: 10.1007/s10792-020-01459-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Accepted: 05/29/2020] [Indexed: 12/03/2022]
Abstract
Purpose Pseudoexfoliation syndrome is common in elderly patients and is associated with intraocular pressure elevation. Goniowash is a novel surgical technique to remove pseudoexfoliation material from the irido-corneal angle to decrease intraocular pressure. We assessed the long-term efficacy of Goniowash on relevant parameters in patients with pseudoexfoliation syndrome, after cataract surgery. Methods The study enrolled 122 patients with pseudoexfoliation syndrome, who underwent routine cataract surgery combined with Goniowash. Best-corrected visual acuity, intraocular pressure and medication status were recorded in study participants during 5 years of follow-up. Results Data from 190 eyes (122 patients of average age 73.8 ± 7.7 years) were assessed. Mean best-corrected visual acuity increased from 0.60 to 1.0 (p < 0.001) one year after surgery and remained stable throughout the follow-up. Average intraocular pressure decreased from 26.4 ± 7.3 mmHg pre-operatively to 15.9 ± 3.0 mmHg post operatively at one year (p < 0.001), 16.1 ± 3.3 mmHg (p < 0.001) at 3 years and 16.8 ± 2.9 (p < 0.001) at 5 years. Mean number of ocular hypotensive medications decreased from 1.5 ± 0.8 pre-operatively to 0.4 ± 0.7 post-operatively (75% reduction) (p < 0.001). No unexpected and severe adverse events related to the surgical procedure were reported. Conclusions Goniowash combined with cataract surgery provides stable and long-lasting reduction of intraocular pressure and hypotensive medications. It is a safe procedure and may be an alternative for patients with pseudoexfoliation syndrome and elevated intraocular pressure.
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Affiliation(s)
- Tao V Tran
- Center for Ophthalmic Specialized Care (COS), Clinic Montchoisi, Ave Beaumont 9, 1012, Lausanne, Switzerland. .,Glaucoma Research Center, Montchoisi Clinic, Swiss Visio, Lausanne, Switzerland.
| | - Kaweh Mansouri
- Glaucoma Research Center, Montchoisi Clinic, Swiss Visio, Lausanne, Switzerland.,Department of Ophthalmology, University of Colorado, Denver, USA
| | - Andre Mermoud
- Center for Ophthalmic Specialized Care (COS), Clinic Montchoisi, Ave Beaumont 9, 1012, Lausanne, Switzerland.,Glaucoma Research Center, Montchoisi Clinic, Swiss Visio, Lausanne, Switzerland
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Yadav S, Tandon R, Singh R, Pujari A. Viscoelastic cannula acting as a wrecker and saviour during cataract surgery. BMJ Case Rep 2019; 12:12/8/e231778. [PMID: 31420443 DOI: 10.1136/bcr-2019-231778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Saumya Yadav
- Department of Ophthalmology, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Radhika Tandon
- Department of Ophthalmology, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Rashmi Singh
- Department of Ophthalmology, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Amar Pujari
- Department of Ophthalmology, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
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Wilde C, Ross AR, Orr G, Dua H. Iatrogenic cannula-associated ocular injuries during anterior segment surgery: time to re-think luer-lock design? Eye (Lond) 2018; 33:341-342. [PMID: 30361488 DOI: 10.1038/s41433-018-0250-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Accepted: 09/07/2018] [Indexed: 11/10/2022] Open
Affiliation(s)
- Craig Wilde
- Ophthalmology and Visual Sciences, Division of Clinical Neurosciences, B Floor, EENT Centre, Queen's Medical Centre, University of Nottingham, Nottingham, UK
| | - Andrew R Ross
- Ophthalmology and Visual Sciences, Division of Clinical Neurosciences, B Floor, EENT Centre, Queen's Medical Centre, University of Nottingham, Nottingham, UK
| | - Gavin Orr
- Ophthalmology and Visual Sciences, Division of Clinical Neurosciences, B Floor, EENT Centre, Queen's Medical Centre, University of Nottingham, Nottingham, UK
| | - Harminder Dua
- Ophthalmology and Visual Sciences, Division of Clinical Neurosciences, B Floor, EENT Centre, Queen's Medical Centre, University of Nottingham, Nottingham, UK.
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Ting DSJ, Dees C, Ellerton C. Cannula-associated Ocular Injuries during Cataract Surgery: A Preventable Intraoperative Complication? Middle East Afr J Ophthalmol 2017; 24:54-56. [PMID: 28546694 PMCID: PMC5433130 DOI: 10.4103/meajo.meajo_208_15] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Although rare, inadvertently dislodged cannula can occur during cataract surgery. We report two cases of cannula-associated ocular injury during stromal hydration of the main corneal incision despite the use of Luer-lock syringes. Case 1 suffered from an initially occult intraocular injury which led to a delayed presentation of vitreous prolapsing into the anterior chamber, presumed posterior capsular rupture, vitreous hemorrhage, and multiple retinal tears, which required a three-port pars plana vitrectomy and cryotherapy. Case 2 sustained an iris laceration, anterior capsular tear, and postoperative raised intraocular pressure with no late sequelae. The former case highlights the need for close monitoring postoperatively despite the absence of initial apparent evidence of intraocular injury. Herein, we propose a systematic approach in reducing the risk of inadvertent cannula-associated ocular injury.
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Affiliation(s)
- Darren Shu Jeng Ting
- Department of Ophthalmology, The James Cook University Hospital, Middlesbrough TS4 3BW, UK
| | - Chrisjan Dees
- Department of Ophthalmology, The James Cook University Hospital, Middlesbrough TS4 3BW, UK
| | - Christine Ellerton
- Department of Ophthalmology, The James Cook University Hospital, Middlesbrough TS4 3BW, UK
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Kim JE, Lee MW. A Case of a Corneal Stromal Penetrating Injury via an Ejected Needle during Stromal Hydration. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2017. [DOI: 10.3341/jkos.2017.58.6.725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Ju Eun Kim
- Department of Ophthalmology, Dankook University College of Medicine, Cheonan, Korea
| | - Myung Won Lee
- Department of Ophthalmology, Dankook University College of Medicine, Cheonan, Korea
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Cannula-associated ocular injuries during cataract surgery: the North East England Study. Eye (Lond) 2016; 30:764-5. [PMID: 26821760 DOI: 10.1038/eye.2016.3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
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McPherson ZE, Lau OCF, Chen TS, Kam AW, Amjadi S, Zhang MG, Playfair TJ, Agar A, Francis IC. High-speed cannula detachment into the eye during hydrodissection. Ophthalmic Surg Lasers Imaging Retina 2014; 45:347-9. [PMID: 24972389 DOI: 10.3928/23258160-20140624-01] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2013] [Accepted: 02/12/2014] [Indexed: 11/20/2022]
Abstract
Detachment of a hydrodissection cannula during a phacoemulsification procedure appeared to produce no adverse sequelae during surgery. Day 1 postoperatively, two nonpenetrating hemorrhagic retinal lesions were identified; there was no evidence of posterior capsular perforation. Day 6 postoperatively, the pupil was temporally peaked by a fine vitreous strand running to the main-port incision in the superotemporal cornea. This was divided with Nd:YAG laser, and argon laser was applied to encircle the two retinal lesions. Postoperative uncorrected visual acuity remained 6/4 at day 1, day 6, and week 4 (3 weeks after laser application) follow-up visits. Surgeons must accept responsibility for confirming the integrity of the cannula and syringe connection before beginning hydrodissection, which can be highly destructive to intracameral structures.
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Pandey P, Kirkby G. Cannula detachment during cataract surgery: results of a survey. Can J Ophthalmol 2012; 47:280-3. [PMID: 22687307 DOI: 10.1016/j.jcjo.2012.03.022] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2011] [Revised: 12/24/2011] [Accepted: 01/20/2012] [Indexed: 10/26/2022]
Abstract
OBJECTIVE To ascertain whether cannula displacement during cataract surgery with the use of the Luer lock is a common and recognized complication. METHODS A questionnaire was sent to attending physicians on the Royal College of Ophthalmologists U.K. register inquiring about episodes of cannula displacement and complications. RESULTS Despite the use of Luer locks, 60 cases of cannula detachment were reported; 196 respondents experienced this complication, and the most common cause of cannula detachment was stromal hydration (50%). Hydrodissection and viscoelastic were experienced by 18% and 17%, respectively. No severe damage resulted in most cases (76 cases), but some serious complications were reported: retinal damage (9%) and vitreous loss (17%). CONCLUSIONS We recommend that surgeons test the union carefully themselves and then test the system by squirting outside the eye. Additionally, we recommend that a new cannula be used for each stage of the procedure. The viscoelastic cannula, in particular, should not be used for any other purpose.
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Affiliation(s)
- Pravin Pandey
- Department of Ophthalmology, Birmingham & Midland Eye Centre, Birmingham, UK.
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Buys YM, Firat M, Brent MH. Posterior capsular rupture secondary to viscoelastic cannula and luer-lock release during phacotrabeculectomy. Can J Ophthalmol 2009; 44:102-3. [PMID: 19169326 DOI: 10.3129/i08-157] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
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Gupta D, Burton B, Goldsmith C, Ohn M, Raja M. Iatrogenic retinal detachment due to cannula slippage despite use of luer-lock syringe system. J Cataract Refract Surg 2008; 34:1612. [PMID: 18721732 DOI: 10.1016/j.jcrs.2008.04.047] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2008] [Accepted: 04/14/2008] [Indexed: 11/28/2022]
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