EyeWorld is the official news magazine of the American Society of Cataract & Refractive Surgery.
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Now Showing the Latest Ophthalmic Innovations n n O n Figure 5. Post-op migration of silicone oil bubble in the anterior chamber and the IOL is placed with one hap- tic oriented in the direction of the dehiscence. At the conclusion of surgery, hypotony should be avoided by re- forming the anterior chamber and ensuring watertight closure. Altered scleral rigidity and perilimbal scar- ring may necessitate suture place- ment to close the phaco and side-port incisions. Post-op management Rigorous post-op management is necessary to prevent post-op inflam- mation, secondary glaucoma, poste- rior synechiae, and cystoid macular edema (CME). Use of topical steroid drops, nonsteroidal anti-inflamma- tory drops, and cycloplegics are ab- solutely necessary. Subconjunctival injection of steroids should be con- sidered if the intraocular inflamma- tion is not under control. Post-op fibrin may be managed by successful use of intracameral tPA. Vigilant management is necessary to detect and treat CME and worsening of dia- betic retinopathy. Complications Early post-op complications include blepharoptosis, moderate to severe corneal edema, intraocular pressure spike, wound leak, moderate to se- vere post-op iritis, peaked pupil with vitreous in the wound, iris prolapse, incorrect IOL power, IOL decentra- tion or dislocation, endophthalmi- tis, macular phototoxicity, retinal detachment, and vitreous hemor- rhage. Silicone oil migration (Figure 5) to the anterior chamber may occur early as well as late in the post-op period. Late post-op complications that occur more than a week after surgery include blepharoptosis, moderate to severe corneal edema, pseudophakic bullous keratopathy, chronic iritis, irregular pupil, neovascularization of the iris, capsulorhexis contraction Figure 6. Post-op anterior capsular phimosis Source (all): Arup Chakrabarti, M.S. (Figure 6), IOL decentration, and posterior capsular opacification. Posterior segment complications include new or persistent macular edema, persistent recurrent choroidal neovascularized mem- brane, proliferative diabetic retinopathy, reopened macular hole, retinal detachment, visually signifi- cant epiretinal membrane, and vitreous hemorrhage. Conclusion By recognizing the differences in the physiologic state of the vitrec- tomized eye and keeping in mind the nature of the patient's previous vitreoretinal pathology, the modern cataract surgeon may readily adapt a small incisional phaco technique to this challenging patient population. The principles discussed in this arti- cle will hopefully minimize surgical difficulty and help reduce complica- tions. EW References 1. Blakenship GW, Machemer R, et al. Long-term diabetic vitrectomy results. Report of l0 year follow-up. Ophthalmology 1985; 92:503-6. 2. de Bustros S, Thompson JT, Michels R G, et al. Nuclear sclerosis after vitrectomy for epiretinal membranes. Am J Ophthalmology 1988; 105:160-4. 3. Thompson MA, Melberg NS, et al. Nuclear sclerotic cataract after vitrectomy for patients younger than 50 years of age. Ophthalmology 1995; 102:1466-1471. 4. Ogura Y, Takanash T, et al. Quantitative analysis of lens changes after vitrectomy by fluorophotometry. Am J Ophthalmol 1991; 111:179-83. Editors' note: Dr. Chakrabarti has no financial interests related to this article. Contact information Chakrabarti: arupeye@gmail.com a Pre-Op and Intra-Op Marks All in One! Scan to Watch the Video ji T -i h s o 'JUT UISPVHI incision! Scan to View Online K L A D With Safety Platform. Left (AE-5666) and 3JHIU "& $POmHVSBUJPOT NN NEW! Scan for Cornea Booklet NOW AVAILABLE!!! Scan to View - Brand New 2012 Catalog Supplement ASCRS BOOTH #1229 APAO BOOTH #334 AD95-12 k p A r e t f 7 2 4 E a c r e 9 4 3 - M o 9 L , 4 6 5 p F T s r R 6 e t e C C N o s k A T 6 S - e h V C a h a s i c S a n A A s E E e - - r