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Maintaining watertight chamber lessens risk for vitreous loss
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 Louis D. "Skip" Nichamin |
NEW YORK — Ophthalmologists should be armed with a contingency plan for the rare case when a capsule is broken during cataract surgery, a speaker told colleagues here.
"Aside from endophthalmitis, breaking a capsule and violating the vitreous remains, arguably, our single most feared complication," Louis D. "Skip" Nichamin, MD, OSN Cataract Surgery Board Member, said at OSN New York 2011.
However, adhering to the tenets employed by vitreoretinal specialists — maintaining a closed chamber, ensuring a watertight environment for all maneuvers, minimizing turbulence and avoiding unnecessary vitreoretinal traction forces — should ensure that the final visual and anatomic outcomes of these complex cases equal those of an uncomplicated case, Dr. Nichamin said.
"When faced with a threat, we have to have the discipline to stop working and not retreat from the eye," he said. "Stay in the eye. Stay in position one. Stabilize the anterior chamber with viscoelastic, and then withdraw the instrumentation, because loss of anterior chamber depth can cause an open capsule case to turn into a vitreous loss case."
The goals for managing the case, Dr. Nichamin said, are to avoid losing the lens, remove all accessible lens material, perform a proper vitrectomy and avoid enlarging the capsular opening while preserving capsular support.
- Disclosure: Dr. Nichamin has no relevant financial disclosures.
Dr. Nichamin has taught a generation of ophthalmologists like me how to safely recover from a ruptured posterior capsule during cataract surgery. One of his key principles is keeping a pressurized, watertight chamber to minimize the risk of vitreous loss. When a pressure gradient is created in the eye, such as low pressure in the anterior chamber from a leaking incision, vitreous will flow from the area of higher pressure, the vitreous cavity, to the leaky incisions. This increases the vitreous prolapse and contributes to further complications. The take-home message is clear: When performing an anterior vitrectomy, operate like a vitreoretinal surgeon by maintaining a pressurized eye with watertight incisions.
– Uday Devgan, MD, FACS, FRCS
OSN
SuperSite Section Editor
Disclosure: Dr. Devgan has no relevant financial
disclosures.