JAN 2014

EyeWorld is the official news magazine of the American Society of Cataract & Refractive Surgery.

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38 EW FEATURE February 2011 Phaco and vitrectomy January 2014 Phaco in post-vitrectomy cases by Ellen Stodola EyeWorld Staff Writer Tips & pearls to remember when performing phaco in post-vitrectomy eyes W hen performing phaco in post-vitrectomy eyes, surgeons may want to use caution. Suber S. Huang, MicroSure™ Retinal and Small Incision Series MD, professor and vice-chair, Department of Ophthalmology and Visual Sciences, Case Western Reserve University, and director, Center for Retina and Macular Disease, University Hospital Eye Institute, Cleveland; Nicole Fram, MD, Advanced Vision Care, Los Angeles, and clinical instructor, Jules Stein Eye Institute, UCLA; and Rosa Braga-Mele, MD, professor of ophthalmology, University of Toronto, and director of cataract surgery, Kensington Eye Institute, Toronto, commented on tips for doing phaco in post-vitrectomy cases. Risk of complications ST5-7000 20GA Straight, Serrated Gripping Jaws *ST5-7005 20GA Straight, Standard End Gripping Jaws ST5-7035 23GA Small Incision, Utrata Capsulorhexis Forceps Dr. Huang said there is no evidence to conclusively support that there is a greater risk of complications in patients who have previously undergone vitrectomy surgery. "Modern phaco techniques limit stress on the lens-iris complex and minimize fluidic surge," he said. "Whether the vitreous plays a role in stabilizing the posterior capsule is also unclear." However, he did say AT A GLANCE • Eyes that have previously undergone vitrectomy may have a deepened anterior chamber and offer less support during lens surgery. • Be aware of zonular weakness when performing phaco in postvitrectomy eyes, and use techniques that limit zonular stress and stabilize the capsule. • Optimizing fluidics reduces the risk of complications. that there is a good chance that capsular hypermotility can increase the risk of capsular tears, CME, dislocated lens fragments, and retinal tear/detachment. "Rapidly progressive cataracts following pars plana vitrectomy and use of intraocular gas or silicone oil can be a special challenge if unanticipated." Dr. Huang noted that historically, it has been thought that there is a higher risk for complications when performing cataract surgery in continued on page 40 Limbal continued from page 36 *ST5-7050 25GA Asymmetrical Forceps ST5-7056 23GA Asymmetrical Forceps ST7-1715 23GA Curved, Horizontal Scissors *ST7-1720 20GA Straight, Horizontal Scissors * Item not pictured Lightweight, Durable, Non-Corrosive .... Affordable 2500 Sandersville Rd., Lexington, KY 40511 USA Phone: 800-354-7848, 859-259-4924 Fax: 859-259-4926 E-Mail: stephensinst@aol.com www.stephensinst.com surgeons who are not experienced with it. Dr. Condon said he does not want cataract surgeons to overlook the limbal approach because it is effective in the cases that it is indicated. He described the process: "You make the incision in the limbus, put the instrument in, push it all the way down back through the pupil, and then start to vitrectomize. So you're not doing it in the anterior chamber, you're doing it in the posterior chamber, but you made the incision to get there in the cornea rather than the pars plana. The pars plana incision is 3.5 mm behind your limbal incision. The difference is the iris is between the two." Dr. Condon said there is currently a fallacy that going through the limbus pulls vitreous into the front of the eye, but this is not true, and cataract surgeons should not let this dissuade them from using it. "You can go through the limbus, place the tip of the instrument over the optic nerve and do your vitrectomy. It's the tip of the instrument where the action is happening. So if you place the tip of that instrument far enough posteriorly, it accomplishes the same thing as doing it through the pars plana— it's all about accessibility of the stuff you want to remove besides the vitreous," he said. EW Editors' note: The physicians have no financial interests related to this article. Contact information Condon: garrycondon@gmail.com Dewey: deweys@prodigy.net Fine: h_f_fine@yahoo.com

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