This article is more than 5 years old. Information may no longer be current.
Cataract surgeons can apply simple anterior vitrectomy principles to complicated cases
WAIKOLOA, Hawaii — By adopting a few simple anterior vitrectomy principles, cataract surgeons can better prepare to deal with complicated phacoemulsification cases, according to a presenter here.
|
|
Retina specialist Allen C. Ho, MD, discussed anterior vitrectomy principles for the anterior segment surgeons at Hawaiian Eye 2008.
When faced with a complicated case involving a perforated capsular bag and leaking vitreous, surgeons must first identify the break in the bag and stabilize the anterior chamber, Dr. Ho said. Then they should put a suture in and safely remove the vitreous gel before proceeding to remove the lens fragments.
"There is nothing more disconcerting than [having] a patient who is aphakic, and [being] asked to remove the lens particles, reconstruct the anterior segment and then place the lens, because we typically are not confident in the lens calculations," Dr. Ho said.
"Get that gel out first safely, get those fragments out and don't chase the fragments," he said.
The first main principle is to identify the capsular tear early.
"If you recognize that there is a disruption in the posterior capsule, consider stopping the ultrasound and phaco. What that does is it begins to exert traction and pulling on the vitreous gel," he said.
He recommended switching to irrigation mode, injecting a dispersive viscoelastic to protect the cornea and pushing the vitreous posteriorly.
Dr. Ho said surgeons should not become too focused on removing all lens fragments.
"The eye is incredibly tolerant of residual lens fragments. Sometimes, if we have a quarter or a third of the lens in the back of the eye, we'll just watch those patients," he said. "Indications for vitrectomy for patients with retained lens fragments include inflammation, increased IOP or something visually disturbing."
The second goal of managing a broken capsule is to retain as much of the normal anatomy of the anterior segment as possible to prepare for IOL implantation. The third goal is to retain the normal retinal anatomy.
Ultimately, the objective is to achieve a closed system. Remove the vitreous before the lens fragments by maintaining a high cutting rate and a low aspiration rate.
"We want to nibble that vitreous and sit there and remove [it] very carefully with little traction," Dr. Ho said.