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Wang D, Shi J, Guan W, Zhu M, Lou X, Zhao Y, Chang P, Zhao Y. Fluid Supplementation Through Weakened Zonules via Side-Port Incision to Maintain Intraocular Pressure in High Myopic Eyes. Ophthalmol Ther 2023; 12:3323-3336. [PMID: 37812307 PMCID: PMC10640526 DOI: 10.1007/s40123-023-00814-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 09/05/2023] [Indexed: 10/10/2023] Open
Abstract
INTRODUCTION During phacoemulsification, the infusion pressure can cause the liquefied vitreous fluid to escape through the ciliary fiber interspace in highly myopic eyes, leading to reduced vitreous cavity pressure similar to vitrectomized eyes. This study assessed the probability of low intraocular pressure (IOP) in high myopic eyes with different axial length (AL) group undergoing cataract surgery, as well as the impact of balanced salt solution (BSS) supplementation and the optimal IOP value for such supplementation. METHODS The control group consisted of cataract eyes with normal AL (group 1: 22 mm ≤ AL < 24.5 mm), while cataract eyes with high axial myopia were categorized into three groups (group 2: 26 mm ≤ AL < 28 mm, group 3: 28 mm ≤ AL < 30 mm, group 4: AL ≥ 30 mm). IOP was measured using the iCare pro tonometer intraoperatively. BSS supplementation was performed to raise IOP in cases of low IOP, before intraocular lens (IOL) implantation and before the end of surgery. The probability of low IOP was calculated, and the IOP before and after supplementation were compared. RESULTS Ninety-five eyes were included. The total probability of low IOP in groups 2, 3, and 4 was 56.52, 62.50, and 70.83%, respectively, significantly higher than that in group 1 (16.67%). Similarly, the probability of low IOP before IOL implantation was significantly higher in groups 2, 3, 4 (43.48, 41.67, and 62.50%) compared to group 1 (4.17%, P < 0.05). The IOP before and after the first BSS supplementation in three high myopia groups were statistically significant (P < 0.05), increasing from 12.10 mmHg (range, 6.0-24.9 mmHg) to 16.60 mmHg (range, 10.2-34.4 mmHg). After the second BSS supplementation before the end of surgery, the IOP of high myopia groups increased from 12.60 mmHg (range, 7.0-25.3 mmHg) to 14.60 mmHg (range, 9.8-25.3 mmHg). CONCLUSIONS The condition of highly myopic eyes seems more likely to develop low IOP during cataract surgery. There is an observed correlation: as AL increases, the total probability of low IOP rises. In patients with IOP < 9.5 mmHg intraoperatively, fluid supplementation via a side-port incision can effectively raise IOP to about 16 mmHg before IOL implantation and about 14 mmHg after incision sealing, facilitating smoother IOL implantation and reducing the risk of postoperative low IOP. TRIAL REGISTRATION NCT, NCT05201677. Registered 23 November 2021-Retrospectively registered, https://clinicaltrials.gov/ct2/show/NCT05201677 .
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Affiliation(s)
- Dandan Wang
- Eye Hospital and School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, 325000, Zhejiang, China
- National Clinical Research Center for Ocular Diseases, Wenzhou, 325000, Zhejiang, China
- Eye Hospital of Wenzhou Medical University, Hangzhou Branch, 618 Fengqi Road, Hangzhou, 310000, Zhejiang, China
| | - Jingyi Shi
- Eye Hospital and School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, 325000, Zhejiang, China
- National Clinical Research Center for Ocular Diseases, Wenzhou, 325000, Zhejiang, China
- Eye Hospital of Wenzhou Medical University, Hangzhou Branch, 618 Fengqi Road, Hangzhou, 310000, Zhejiang, China
| | - Weichen Guan
- Eye Hospital and School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, 325000, Zhejiang, China
- National Clinical Research Center for Ocular Diseases, Wenzhou, 325000, Zhejiang, China
- Eye Hospital of Wenzhou Medical University, Hangzhou Branch, 618 Fengqi Road, Hangzhou, 310000, Zhejiang, China
| | - Minying Zhu
- Eye Hospital and School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, 325000, Zhejiang, China
- National Clinical Research Center for Ocular Diseases, Wenzhou, 325000, Zhejiang, China
- Eye Hospital of Wenzhou Medical University, Hangzhou Branch, 618 Fengqi Road, Hangzhou, 310000, Zhejiang, China
| | - Xicong Lou
- Eye Hospital and School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, 325000, Zhejiang, China
- National Clinical Research Center for Ocular Diseases, Wenzhou, 325000, Zhejiang, China
- Eye Hospital of Wenzhou Medical University, Hangzhou Branch, 618 Fengqi Road, Hangzhou, 310000, Zhejiang, China
| | - Yinying Zhao
- Eye Hospital and School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, 325000, Zhejiang, China
- National Clinical Research Center for Ocular Diseases, Wenzhou, 325000, Zhejiang, China
- Eye Hospital of Wenzhou Medical University, Hangzhou Branch, 618 Fengqi Road, Hangzhou, 310000, Zhejiang, China
| | - Pingjun Chang
- Eye Hospital and School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, 325000, Zhejiang, China
- National Clinical Research Center for Ocular Diseases, Wenzhou, 325000, Zhejiang, China
- Eye Hospital of Wenzhou Medical University, Hangzhou Branch, 618 Fengqi Road, Hangzhou, 310000, Zhejiang, China
| | - Yune Zhao
- Eye Hospital and School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, 325000, Zhejiang, China.
- National Clinical Research Center for Ocular Diseases, Wenzhou, 325000, Zhejiang, China.
- Eye Hospital of Wenzhou Medical University, Hangzhou Branch, 618 Fengqi Road, Hangzhou, 310000, Zhejiang, China.
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Vinod K, Salim S. Addressing Glaucoma in Myopic Eyes: Diagnostic and Surgical Challenges. Bioengineering (Basel) 2023; 10:1260. [PMID: 38002384 PMCID: PMC10669452 DOI: 10.3390/bioengineering10111260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Revised: 10/23/2023] [Accepted: 10/27/2023] [Indexed: 11/26/2023] Open
Abstract
Epidemiological and genetic studies provide strong evidence supporting an association between myopia and glaucoma. The accurate detection of glaucoma in myopic eyes, especially those with high myopia, remains clinically challenging due to characteristic morphologic features of the myopic optic nerve in addition to limitations of current optic nerve imaging modalities. Distinguishing glaucoma from myopia is further complicated by overlapping perimetric findings. Therefore, longitudinal follow-up is essential to differentiate progressive structural and functional abnormalities indicative of glaucoma from defects that may result from myopia alone. Highly myopic eyes are at increased risk of complications from traditional incisional glaucoma surgery and may benefit from newer microinvasive glaucoma surgeries in select cases.
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Affiliation(s)
- Kateki Vinod
- Department of Ophthalmology, Icahn School of Medicine at Mount Sinai, New York Eye and Ear Infirmary of Mount Sinai, New York, NY 10003, USA
| | - Sarwat Salim
- Department of Ophthalmology, Tufts University School of Medicine, Boston, MA 02116, USA
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Elhusseiny AM, Salim S. Cataract surgery in myopic eyes. Curr Opin Ophthalmol 2023; 34:64-70. [PMID: 36473016 DOI: 10.1097/icu.0000000000000914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
PURPOSE OF REVIEW We discuss the preoperative, intraoperative, and postoperative considerations for cataract surgery in eyes with high myopia. We also reviewed the recent literature on refractive outcomes and complications of cataract surgery in myopic eyes. RECENT FINDINGS Several novel intraocular lens (IOL) power calculation formulas have recently been developed to optimize refractive outcomes. Haigis formula is the most accurate among the third-generation IOL formulas. Novel formulas such as Barrett Universal II, Kane, and modified Wang-Koch adjustment for Holladay I formula provide a better refractive prediction compared with old formulas. Intraoperatively, the chopping technique is preferred to minimize pressure on weak zonules and reduce the incidence of posterior capsule rupture. Anterior capsular polishing is recommended to reduce the risk of postoperative capsular contraction syndrome (CCS). Postoperatively, complications such as refractive surprises, intraocular pressure spikes, and CCS remain higher in myopic eyes. Only 63% of myopic patients with axial length more than 26 mm achieve a visual acuity at least 20/40 after cataract surgery, mainly because of coexisting ocular comorbidities. SUMMARY There are multiple preoperative, intraoperative, and postoperative considerations when performing cataract surgery in myopic eyes. Further research is needed to optimize the refractive outcomes in these eyes and determine the best IOL formula. Surgeons should be adept and knowledgeable with different techniques to manage intraoperative complications.
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Affiliation(s)
- Abdelrahman M Elhusseiny
- Department of Ophthalmology, Harvey and Bernice Jones Eye Institute, University of Arkansas for Medical Sciences, Little Rock, Arkansas.,Department of Ophthalmology, Boston Children's Hospital, Harvard Medical School
| | - Sarwat Salim
- Department of Ophthalmology, Tufts University School of Medicine, Boston, Massachusetts, USA
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Hallali G, Aubert T, Souied EH, Glacet-Bernard A. Lens-Iris diaphragm retropulsion syndrome: Risk factors and management. A prospective study. Eur J Ophthalmol 2022; 33:1361-1366. [PMID: 36464664 DOI: 10.1177/11206721221143618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/08/2022]
Abstract
Purpose The lens-iris diaphragm retropulsion syndrome (LIDRS) corresponds to an acute deepening of the anterior chamber during phacoemulsification. LIDRS is painful for the patient and sometimes causes intraoperative complications. This study was designed to assess the preoperative risk factors of LIDRS and its outcome. Setting Monocentric study in the university department of ophthalmology, Intercommunal Hospital Center, Creteil, France. Design Prospective observational study. Methods Preoperative parameters of consecutive patients who underwent cataract surgery were recorded. LIDRS occurrence was evaluated during surgery and classified into 3 stages. Except for the first patient, a simple and rapid maneuver to separate the iris from the capsule was performed in all patients with LIDRS. Results LIDRS occurred in 101 out of 205 included eyes: mild in 73.2%, marked in 16.8%, and severe in 9.9%. LIDRS patients were younger, and had a longer axial length and a thinner lens than the control group (p < 0.01 for all). Univariate logistic regression showed that the main predictive factors of LIDRS were long axial length and decreased lens thickness. LIDRS occurred in 83% (5/6) of eyes with prior vitrectomy. Complications occurred (zonular dehiscence, lens or IOL dislocation), especially in vitrectomized eyes. The maneuver separating the iris from the capsule allowed almost all eyes to restore normal chamber depth and prevent complications. Conclusions Myopia and prior vitrectomy were the main risk factors of LIDRS. The maneuver separating the iris from the capsule allowed almost all eyes to resolve LIDRS. Analysis of preoperative factors can help the surgeon identify patients at risk and prevent patient pain and intraoperative complications associated with LIDRS.
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Affiliation(s)
- Gabriel Hallali
- Department of Ophthalmology, Intercommunal Hospital Center and Henri Mondor Hospital, Paris-Est Créteil University (UPEC, Paris XII University), 40 avenue de Verdun, 94000 Creteil, France
| | - Tristan Aubert
- Department of Ophthalmology, Intercommunal Hospital Center and Henri Mondor Hospital, Paris-Est Créteil University (UPEC, Paris XII University), 40 avenue de Verdun, 94000 Creteil, France
| | - Eric H Souied
- Department of Ophthalmology, Intercommunal Hospital Center and Henri Mondor Hospital, Paris-Est Créteil University (UPEC, Paris XII University), 40 avenue de Verdun, 94000 Creteil, France
| | - Agnès Glacet-Bernard
- Department of Ophthalmology, Intercommunal Hospital Center and Henri Mondor Hospital, Paris-Est Créteil University (UPEC, Paris XII University), 40 avenue de Verdun, 94000 Creteil, France
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Markatia Z, Hudson J, Leung EH, Sajjad A, Gibbons A. The Postvitrectomy Cataract. Int Ophthalmol Clin 2022; 62:79-91. [PMID: 35752887 PMCID: PMC10187786 DOI: 10.1097/iio.0000000000000440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/08/2022]
Abstract
To review the recent literature regarding risk factors for cataract formation after vitrectomy, the challenges and management strategies for anterior segment surgeons when facing post-vitrectomy cataract surgery, and the visual outcomes of patients undergoing post-vitrectomy cataract surgery. Cataract surgery after vitrectomy can be safely performed to significantly improve the visual outcome in most post-vitrectomy patients, although final visual acuity is primarily limited by the patient’s underlying vitreoretinal pathology.
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Affiliation(s)
- Zahra Markatia
- Bascom Palmer Eye Institute / University of Miami, Miami, FL
| | - Julia Hudson
- Bascom Palmer Eye Institute / University of Miami, Miami, FL
| | - Ella H. Leung
- Baylor College of Medicine, Houston, TX
- Georgia Retina, Atlanta, Georgia
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Bai L, Wang YF, Tariq F, Zheng YP, Feng HX, Wang F, Zhang S. Safety and effectiveness of an iris hook assisted phacoemulsification in vitrectomized eyes. Int J Ophthalmol 2021; 14:1735-1740. [PMID: 34804864 DOI: 10.18240/ijo.2021.11.13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Accepted: 07/22/2021] [Indexed: 11/23/2022] Open
Abstract
AIM To introduce a simple iris hook assisted phacoemulsification (PE) procedure and evaluate the safety and efficacy of it in completely vitrectomized eyes. METHODS A single centre study which included 65 previously completely vitrectomized eyes of 62 patients who underwent cataract surgery. Patients were randomly divided into 3 groups. Patients received PE, and intraocular lens (IOL) implantation with the assistance of iris hook (Synergeties™) as group A (25 eyes); patients who received PE assisted with a 25G pars plana irrigation as group B (20 eyes), and patients who received PE performed without the help of any instrument as group C (20 eyes). Main outcome measures were surgery duration, Ultrasound (U/S) total time, endothelial cell density (ECD), cumulative dissipated energy (CDE) and complications of the procedures. RESULTS With the help of iris hook, the patients in group A had the lowest ECD loss rate (0.07±0.03, 0.09±0.03, and 0.10±0.03, P<0.05), shortest CDE (12.2±4.1, 15.8±6.0, and 16.0±6.0, P<0.05) and U/S total time (36.6±13.0s, 46.3±16.4s, and 47.6±16.1s, P<0.05), and minimal incidence of complications. The longest surgery duration was in group B (19.4±1.6min) and maximum complications rate in group C (20% miosis, 10% posterior capsular tears, 5% zonular dialysis, 5% cystoid macular edema). While best-corrected visual acuity (BCVA), intraocular pressure (IOP) and ECD did not show a significant difference among the three groups. CONCLUSION Without prolonged surgery duration, the iris hook assistant method can minimize heat generation during surgery and incidence of complications, which transfer the challenged PE in vitrectomized eyes into a regular surgery. It does not need any change in the hydrodynamic parameters and in the bag PE technique, easy to operate even for junior surgeons.
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Affiliation(s)
- Ling Bai
- Department of Ophthalmology, the Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710004, Shaanxi Province, China
| | - Yan-Fen Wang
- Department of Ophthalmology, the Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710004, Shaanxi Province, China
| | - Farheen Tariq
- Department of Ophthalmology, the Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710004, Shaanxi Province, China
| | - Yu-Ping Zheng
- Department of Ophthalmology, the Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710004, Shaanxi Province, China
| | - Hai-Xiao Feng
- Department of Ophthalmology, the Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710004, Shaanxi Province, China
| | - Feng Wang
- Department of Ophthalmology, the Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710004, Shaanxi Province, China
| | - Shu Zhang
- Experimental Teaching Center for Clinical Skills, the Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710004, Shaanxi Province, China.,Department of Geriatric Medicine, the Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710004, Shaanxi Province, China
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Kasyanov AA, Vinogradova EY. [Distinctive features of phacoemulsification in previously vitrectomized eyes]. Vestn Oftalmol 2020; 136:301-307. [PMID: 33063981 DOI: 10.17116/oftalma2020136052301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The review presents the main pathogenetic mechanisms of cataract development in an avitic eye as well as anatomical and functional changes of the eye in the state of avitria. The authors have also analyzed distinctive behavior of such eyes during phacoemulsification and surgical techniques used to answer specific avitreal phenomena.
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Affiliation(s)
- A A Kasyanov
- Research Institute of Eye Diseases, Moscow, Russia
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Nuzzi R, Monteu F. Big Bag IOL Implantation with Scleral Fixation Technique in IOL/Crystalline Lens Subluxation/Luxation Cases and High Myopia. Int Med Case Rep J 2020; 13:383-389. [PMID: 32943945 PMCID: PMC7467733 DOI: 10.2147/imcrj.s267180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Accepted: 07/24/2020] [Indexed: 12/05/2022] Open
Abstract
Purpose The aim of this study is to report our experience in the surgical management of over 180° luxation/subluxation of the intraocular lens (IOL). Special cases are high myopic eyes, whose tissues are constitutionally more fragile, and consequently, surgery is more dangerous. Patients and Methods The authors propose the use of the Big Bag, three loops, IOL (Zeiss), to be implanted with the scleral fixation technique, with a double-armed needle. This technique seems to improve IOL stability and visual outcome of these patients. Results Big Bag IOL implantation with the scleral fixation technique in eyes with subluxation (over 180°) of the cataractous lens, high myopia and subluxation/dislocation of the IOL seems to suggest a possible and optimal management, with good long-term results and it is well tolerated by the patient. Conclusion This specific ocular surgical technique can be used/standardized in all surgical “converted” complicated cases and especially in high myopic eyes.
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Affiliation(s)
- Raffaele Nuzzi
- Department of Surgical Sciences, University Eye Clinic, Molinette Hospital, Torino, Italia
| | - Francesca Monteu
- Department of Surgical Sciences, University Eye Clinic, Molinette Hospital, Torino, Italia
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Al Amro SA. Managing Challenges of Phacoemulsification in Vitrectomized Eyes: A New Technique. Middle East Afr J Ophthalmol 2020; 27:53-55. [PMID: 32549725 PMCID: PMC7276175 DOI: 10.4103/meajo.meajo_257_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Revised: 02/26/2020] [Accepted: 03/17/2020] [Indexed: 11/25/2022] Open
Abstract
AIM: This study aimed to describe a novel approach to manage the challenges of phacoemulsification in vitrectomized eyes. METHODS: Intraoperative titrated intravitreal injection of balanced salt solution (BSS) through pars plana was done using a 30G needle hooked to a 1 cc syringe to build up the vitreous pressure. RESULTS: Five eyes of five patients who had previous vitrectomy were given intraoperative injection. This led to the prevention of lens–iris diaphragm retropulsion and routine completion of phacoemulsification. The preoperative visual acuity was < 6/60 in all patients. The postoperative visual acuity was 6/9 or better in all patients, except in one patient which was 6/60, which is explained by diabetic ischemic maculopathy. Neither injection-related intraoperative nor postoperative complications were noted. CONCLUSION: Challenges of phacoemulsification in vitrectomized eyes can be prevented by a simple titrated intraoperative injection of BSS intravitreally through pars plana.
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Affiliation(s)
- Saleh A Al Amro
- The Eye Consultants, Riyadh, Saudi Arabia.,King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia
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Intraoperative Posterior Chamber Irrigation to Enhance Vitreous Cavity Support during Phacoemulsification Cataract Surgery after Vitrectomy. J Ophthalmol 2020; 2020:4132456. [PMID: 32148943 PMCID: PMC7048943 DOI: 10.1155/2020/4132456] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2019] [Accepted: 01/16/2020] [Indexed: 11/17/2022] Open
Abstract
Purpose To report the effectiveness of an intraoperative posterior chamber irrigation technique to enhance vitreous cavity support during postvitrectomy phacoemulsification cataract surgery. Methods The irrigation technique was performed during phacoemulsification cataract surgery on 10 postvitrectomy eyes (9 patients) with moderate or hard density cataracts and with low vitreous cavity support. A cohesive viscoelastic tamponade was applied to pressurize the anterior chamber to start the procedure. The vitreous cavity was then irrigated using a 26-gauge flushing cannula injecting balanced salt solution under the iris through the zonules, until the vitreous cavity pressure balanced and exceeded the anterior chamber pressure and viscoelastic flowed out from the corneal incision. Intraoperative performance with the irrigation technique, postoperative visual acuity, and anatomy, and complications were retrospectively evaluated. Results The irrigation procedure instantly enhanced posterior segment pressure before capsulorhexis in 4 eyes, before phacoemulsification in 4 eyes, after phacoemulsification in 2 eyes, before intraocular lens implantation in 6 eyes, and after implantation in 3 eyes. Phacoemulsification cataract surgery was facilitated by the irrigation technique, with a stabilized anterior chamber and robust vitreous cavity support. No complications occurred intraoperatively and postoperatively. At a 3-month follow-up, favorable visual and anatomic outcomes were achieved in all eyes. Conclusions The irrigation technique balanced the pressure of anterior and posterior segments. Thus, vitreous cavity support and anterior chamber depth were well stabilized during phacoemulsification cataract surgery in postvitrectomy eyes.
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Fluidics and rheology in phaco surgery: what matters and what is the hype? Eye (Lond) 2018; 32:204-209. [PMID: 29350690 DOI: 10.1038/eye.2017.299] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2017] [Accepted: 10/29/2017] [Indexed: 11/08/2022] Open
Abstract
Rheology can be defined as the study of materials flow behaviour under applied deformation forces (stresses). Inside the eye during cataract surgery, transient or reversible deformation (elasticity) and permanent or irreversible deformation (flow) can both apply. Although the fluidics of modern phaco machines is an important part of this talk, there are a number of issues relating to flow and fluids in the eye during cataract surgery, which are unrelated to the machine, which can hinder or help the operating surgeon in removing a cataract. In addition, coping with the numerous complications, which can occur in the eye at the time of surgery, relies on an understanding of how fluidics and rheology can help to control the pressurised eye and bring the surgery to a successful conclusion.
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Lim DH, Shin DH, Han G, Chung ES, Chung TY. The Incidence and Risk Factors of Lens-iris Diaphragm Retropulsion Syndrome during Phacoemulsification. KOREAN JOURNAL OF OPHTHALMOLOGY 2017; 31:313-319. [PMID: 28682016 PMCID: PMC5540986 DOI: 10.3341/kjo.2016.0050] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2016] [Accepted: 09/02/2016] [Indexed: 11/23/2022] Open
Abstract
PURPOSE In the present study, the incidence and risk factors of lens-iris diaphragm retropulsion syndrome (LIDRS) were evaluated. METHODS Patients who underwent cataract surgery using phacoemulsification between June 2014 and December 2014 were included in the study. The preoperative ocular biometric and intraoperative surgical parameters were examined. The incidence of LIDRS and various risk factors were analyzed using an independent t-test, Pearson's chi-square test, and univariable and multivariable logistic regression analyses. RESULTS Among 124 eyes of 124 patients, 100 (80.6%) had no LIDRS and 24 (19.4%) had LIDRS. LIDRS occurred in 13 of 31 vitrectomized eyes (41.9%) and 11 of 93 non-vitrectomized eyes (11.8%). Based on univariable analysis, age (odds ratio [OR], 0.920; p = 0.001), vitrectomized eye (OR, 5.038; p = 0.001), spherical equivalent (OR, 0.778; p < 0.001), axial length (OR, 1.716; p < 0.001), anterior chamber depth (OR, 3.328; p = 0.037), and 3.0 mm vs. 2.2 mm incision size (OR, 4.964; p = 0.001) were statistically significant risk factors associated with the development of LIDRS. Conditional multivariable logistic regression showed that vitrectomized eye (OR, 3.865; 95% confidence interval [CI], 1.201 to 12.436; p = 0.023), long axial length (OR, 1.709; 95% CI, 1.264 to 2.310; p = 0.001), and 3.0 vs. 2.2 mm incision size (OR, 3.571; 95% CI, 1.120 to 11.393; p = 0.031) were significant independent risk factors associated with LIDRS. CONCLUSIONS LIDRS is a relatively common occurrence and was found to be associated with vitrectomized eye, long axial length, and larger incision size. Evaluating risk factors prior to cataract surgery can help reduce associated morbidity.
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Affiliation(s)
- Dong Hui Lim
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.,Department of Preventive Medicine, Graduate School, The Catholic University of Korea, Seoul, Korea
| | - Dong Hoon Shin
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Gyule Han
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Eui Sang Chung
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Tae Young Chung
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
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Anisimova N, Malyugin B, Arbisser LB, Sobolev N. Femtosecond laser-assisted cataract surgery in vitrectomized eye with posterior chamber phakic intraocular lens. Digit J Ophthalmol 2017; 23:43-44. [PMID: 28924422 DOI: 10.5693/djo.02.2017.03.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
We describe a case of femtosecond laser-assisted cataract surgery (FLACS) in an eye with multiple comorbidities, including retinal detachment surgery, high myopia, posterior chamber phakic intraocular lens (PC pIOL) and residual, emulsified, silicone oil located in the anterior chamber. FLACS was affected by the optical blockage, but the incomplete capsular tear was recoverable. The case suggests that silicone oil bubbles concentrated at the dome of the posterior corneal surface, along with the PC pIOL optic edges and scars after corneal astigmatic relaxing incisions can lead to incomplete anterior capsulotomy.
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Affiliation(s)
| | - Boris Malyugin
- S. Fyodorov Eye Microsurgery State Institution, Moscow, Russia
| | | | - Nikolay Sobolev
- S. Fyodorov Eye Microsurgery State Institution, Moscow, Russia
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In Vivo Imaging of Intraocular Fluidics in Vitrectomized Swine Eyes Using a Digital Fluoroscopy System. J Ophthalmol 2016; 2016:9695165. [PMID: 27127645 PMCID: PMC4834173 DOI: 10.1155/2016/9695165] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2015] [Revised: 02/20/2016] [Accepted: 03/02/2016] [Indexed: 11/18/2022] Open
Abstract
Purpose. To describe the characteristics of intraocular fluidics during cataract surgery in swine eyes with prior vitrectomy. Methods. We prepared three groups of enucleated swine eyes (nonvitrectomized, core, and totally vitrectomized). Irrigation and aspiration were performed (2.7 mm conventional sleeved phacosystem) using a balanced saline solution mixed with a water-soluble radiopaque contrast medium at 1 : 1 ratio. We imaged the eyes using a digital fluoroscopy system (DFS) during phacoemulsification and compared the characteristics of the intraocular fluid dynamics between the groups. Results. The anterior chamber depth (ACD) after the commencement of irrigation differed between groups (2.25 ± 0.06 mm; 2.33 ± 0.06 mm; 3.17 ± 0.11 mm), as well as the height of the fluid flowing from the anterior chamber into the posterior cavity that was identified by lifting up the iris to correct the infusion deviation syndrome (0.00 ± 0.00 mm; 0.41 ± 0.04 mm; 2.19 ± 0.35 mm). Conclusions. DFS demonstrated differences in fluid dynamics during phacoemulsification in swine eyes with or without prior vitrectomy. In completely vitrectomized eyes, the large ACD, which developed during phacoemulsification, could be reduced by lifting the iris and allowing the fluid to shift to the posterior cavity. Recognizing the differences in fluidics of vitrectomized eyes as compared to those of the nonvitrectomized eyes may reduce the frequency of intraoperative complications.
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Rouhette H, Conté M, Guillemot F. [Successful phacoemulsification in vitrectomized eyes: technical considerations]. J Fr Ophtalmol 2014; 37:245-9. [PMID: 24556082 DOI: 10.1016/j.jfo.2013.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2013] [Revised: 11/06/2013] [Accepted: 11/20/2013] [Indexed: 10/25/2022]
Abstract
Cataract surgery after pars plana vitrectomy significantly improves visual acuity in 85% of cases, limited by retinal comorbidity and surgical complications. However, despite recent advances, this surgery remains a special challenge. Indeed, the surgeon must be aware of its many pitfalls and often adapt his surgical technique to avoid the 10% rate of intraoperative complications reported in the literature - ten times higher than for the non-vitrectomized eye. During the postoperative period, the most common complication is posterior capsule opacification, which may require early laser capsulotomy.
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Affiliation(s)
- H Rouhette
- Centre ophtalmologique de Mougins, Collectif P1,5, 80, allée des Ormes, 06250 Mougins, France.
| | - M Conté
- Centre ophtalmologique de Mougins, Collectif P1,5, 80, allée des Ormes, 06250 Mougins, France
| | - F Guillemot
- Centre ophtalmologique de Mougins, Collectif P1,5, 80, allée des Ormes, 06250 Mougins, France
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Lens–iris diaphragm retropulsion syndrome during phacoemulsification in vitrectomized eyes. J Cataract Refract Surg 2013; 39:1852-8. [DOI: 10.1016/j.jcrs.2013.06.017] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2013] [Revised: 06/06/2013] [Accepted: 06/06/2013] [Indexed: 11/19/2022]
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17
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Lockington D, Luo X, Wang H, Hill NA, Ramaesh K. Mathematical and computer simulation modelling of intracameral forces causing pupil block due to air bubble use in Descemet's Stripping Endothelial Keratoplasty: the mechanics of iris buckling. Clin Exp Ophthalmol 2011; 40:182-6. [DOI: 10.1111/j.1442-9071.2011.02653.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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18
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Packard RB. Avoiding lens-iris diaphragm retropulsion syndrome. J Cataract Refract Surg 2010; 36:1245. [PMID: 20610115 DOI: 10.1016/j.jcrs.2010.04.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2010] [Indexed: 10/19/2022]
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19
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Osher RH, Osher JM, Cionni RJ. Multifocal iris sphincter ruptures: new sign of the lens-iris diaphragm retropulsion syndrome. J Cataract Refract Surg 2010; 36:170-2. [PMID: 20117722 DOI: 10.1016/j.jcrs.2009.06.045] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2009] [Revised: 06/26/2009] [Accepted: 06/28/2009] [Indexed: 11/24/2022]
Abstract
We describe the case of a 78-year-old highly myopic woman who had bilateral phacoemulsification with posterior chamber intraocular lens implantation. During surgery, the anterior chamber was extremely deep and the pupil was excessively dilated, consistent with lens-iris diaphragm retropulsion syndrome (LIDRS). Subsequent biomicroscopy revealed multifocal iris sphincter ruptures, a new finding associated with LIDRS.
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Affiliation(s)
- Robert H Osher
- University of Cincinnati, College of Medicine, Cincinnati Eye Institute, Cincinnati, Ohio 45242, USA.
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Higashide T, Shimizu F, Nishimura A, Sugiyama K. Anterior segment optical coherence tomography findings of reverse pupillary block after scleral-fixated sutured posterior chamber intraocular lens implantation. J Cataract Refract Surg 2009; 35:1540-7. [DOI: 10.1016/j.jcrs.2009.04.030] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2009] [Revised: 04/04/2009] [Accepted: 04/11/2009] [Indexed: 11/27/2022]
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21
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Morley A, Seyedian M, Tuft S. Scleral collapse following phacoemulsification in vitrectomized eyes. ACTA OPHTHALMOLOGICA SCANDINAVICA 2007; 85:463-4. [PMID: 17309657 DOI: 10.1111/j.1600-0420.2007.00878.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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22
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Mendicute J, Bidaguren A. Lens–iris diaphragm retropulsion syndrome and iridotomies. J Cataract Refract Surg 2007; 33:177; author reply 177. [PMID: 17276247 DOI: 10.1016/j.jcrs.2006.09.038] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2006] [Accepted: 09/22/2006] [Indexed: 11/16/2022]
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23
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Bacsal K, Chee SP. Modified technique for management of LIDRS. J Cataract Refract Surg 2006; 33:4-5. [PMID: 17189775 DOI: 10.1016/j.jcrs.2006.08.053] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2006] [Accepted: 08/29/2006] [Indexed: 10/23/2022]
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24
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Por YM. Iris pigment imprinting in the lens-iris diaphragm retropulsion syndrome. J Cataract Refract Surg 2006; 32:1585-6. [PMID: 16931281 DOI: 10.1016/j.jcrs.2006.04.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2006] [Accepted: 04/05/2006] [Indexed: 10/24/2022]
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25
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Vishwanath MR. Lens-iris diaphragm retropulsion syndrome and iris hooks. J Cataract Refract Surg 2006; 32:708. [PMID: 16765776 DOI: 10.1016/j.jcrs.2006.01.058] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2005] [Indexed: 11/29/2022]
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26
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Cheung CMG, Hero M. Stabilization of anterior chamber depth during phacoemulsification cataract surgery in vitrectomized eyes. J Cataract Refract Surg 2006; 31:2055-7. [PMID: 16412915 DOI: 10.1016/j.jcrs.2005.04.036] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/22/2005] [Indexed: 10/25/2022]
Abstract
Abnormal fluctuations in anterior chamber (AC) depth including deepening and mydriasis with paradoxical shallowing and miosis have been described during phacoemulsification cataract surgery in previously vitrectomized eyes. Contributory factors include zonular laxity and reduction of vitreous volume. This report describes a technique to stabilize AC depth and allow safer sculpting and removal of lens matter.
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Affiliation(s)
- Chui M G Cheung
- Department of Ophthalmology, University Hospitals Coventry and Warwickshire NHS Trust, Stoney Stanton Road, Coventry, United Kingdom.
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27
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Saad DN, Cespedes MC, Palmer AM, Lopez MP. Phacoemulsification and LensIris Diaphragm Retropulsion Syndrome. Ophthalmic Surg Lasers Imaging Retina 2005. [DOI: 10.3928/1542-8877-20051101-14] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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28
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Chee SP, Bacsal K. Management of lens-iris diaphragm retropulsion syndrome. J Cataract Refract Surg 2005; 31:1272-3; author reply 1273. [PMID: 16105583 DOI: 10.1016/j.jcrs.2005.06.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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29
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Lee VYW, Liu DTL, Chan WM, Lam DSC. Management of lens-iris diaphragm retropulsion syndrome. J Cataract Refract Surg 2005; 31:1273-4. [PMID: 16105588 DOI: 10.1016/j.jcrs.2005.06.032] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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30
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Sony P, Khokhar S. Management of lens-iris diaphragm retropulsion syndrome. J Cataract Refract Surg 2005; 31:1272; author reply 1272. [PMID: 16105585 DOI: 10.1016/j.jcrs.2005.06.031] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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31
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Coaxial and Bimanual Phacoemulsification; Considerations in Patient and Technique Selection. ACTA ACUST UNITED AC 2005. [DOI: 10.1097/01.ito.0000167747.70974.02] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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32
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Sharma N, Siinha R, Vajpayee RB. Lens-iris diaphragm retropulsion syndrome during phacoaspiration in pediatric cataracts. J Cataract Refract Surg 2005; 31:460-1. [PMID: 15811725 DOI: 10.1016/j.jcrs.2005.02.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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