Combined Instrument and Posterior-Assisted Levitation of Nuclear Fragments During Phacoemulsification after Posterior Capsule Rupture
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- Category: Vol. 77, June 2009
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Combined Instrument and Posterior-Assisted Levitation of Nuclear Fragments During Phacoemulsification after Posterior Capsule Rupture,OSAMA M. AL-NAHRAWY, WALEED A. GHOBASHY, AMR A. ALI and KHALED A. ZAKI
Abstract
Introduction: Rupture of posterior capsule is a challenging complication especially when the nucleus is still present in the eye. Retained nuclear fragments frequently cause sight threatening complications.
Objective: To report the outcomes of a technique that implies the use of instruments in the anterior chamber and through pars plana to help delivery of fragments outside the eye together with the known posterior assisted levitation technique.
Design: In a retrospective series, the case notes of con-secutive 15 surgeries performed by 4 surgeons between 2007 and 2008 were reviewed.
Patients and Methods: The study comprised fifteen eyes of 15 patients; 10 were females and 5 were males (age ranged between 50-73 yrs, Mean 65 years, STD 9 years). Subjects had rupture of posterior capsule during phacoemulsification. Dislocation of whole nucleus or nuclear fragments into the anterior or mid vitreous cavity occurred. Immediately after this event, dispersive viscoelastic was used to fill the anterior chamber before the phaco tip was removed. Either the MVR knife 19G or the needle of insulin syringe was used, 3.5 mm from the limbus, to levitate the dropped nucleus or fragments into the anterior chamber. Then other instruments (a spatula, a push pull) were used through the side-port incisions to help deliver the fragments through the main incision. The body of a keratome 3 or 5 mm could be used as a guide to carry large and cheesy semisoft pieces from the anterior chamber to the exterior of the eye through the main incision. Widening the main incision and using scoop and hook were used to deliver whole nucleus or large pieces. The technique was concluded with limited anterior vitrectomy and in sulcus implantation of PMMA IOL.
Results: This method was successful in 13 out of 15 eyes (87%) that had hard fragments and could be removed from the eyes safely. Post-operative corneal edema occurred in 2 eyes (13%) that improved over one month. Intraocular pressure was elevated to 25 mmHg in two eyes (13%) for 2 weeks. In one eye (6.7%) the technique failed to deliver nuclear pieces because they were fragmented inside the vitreous cavity during posterior assisted levitation. In another eye (6.7%), whole nucleus dropped posteriorly. Vitrectomy was needed for these two cases (13%).
Conclusions: Instrument assisted removal of dropped fragments during phacoemulsification is a safe procedure that could be used to remove nuclear fragments. It succeeded in most of the cases (87%); minimizing the need for vitrectomy.