ABSTRACT
Manual small-incision cataract surgery (MSICS) has existed as an alternative to conventional phacoemulsification since its inception. The size of the incision has been becoming smaller in MSICS to reduce the surgically induced astigmatism. Smaller incisions go hand in hand with nucleus debulking and fragmenting techniques which have been practiced over almost four decades. Such techniques have a learning curve and require meticulous execution. The authors describe a technique to achieve nucleus bisection or trisection or debulking in a closed anterior chamber. This technique has been in use for a long time; it has shown excellent results and has a shorter learning curve. Since it is done in a closed chamber, the risk to the corneal endothelium is minimized as the anterior chamber remains deep throughout the procedure. Sudden escape of the viscoelastic and shallowing of the chamber are prevented, and the corneal endothelium is well protected. It uses iris as support and reference. The specially designed chopper is an inexpensive addition to the instruments. Fragmentation is achieved in the proximal half of the chamber where control over instruments is maximum. Pristine clear cornea on day 1 is the rule rather than the exception with this technique. This is a safe and repeatable technique for phacofragmentation in cataract extraction
ABSTRACT
A 65?year?old male with proliferative diabetic retinopathy (PDR) and non?clearing vitreous hemorrhage underwent 25G pars plana vitrectomy (PPV). A large disk of thick organized blood of 5 disk diameter (DD) size was encountered in subhyaloid space. All attempts including lower cut rates to remove this disk using a 25G cutter turned futile. We used a 20G fragmatome to safely remove this hard clot from vitreous cavity in 50 s. Surgical time for removal of similar clot of 3 DD by 25G cutter in another eye was 5 min. Removal of thick clotted subhyaloid blood by ultrasonic fragmentation during diabetic vitrectomy is a safe, faster, and useful maneuver.
ABSTRACT
Purpose: To report the outcomes of pars-plana approach for the management of brunescent cataract in eyes with severe microcornea and associated chorio-retinal coloboma. Methods: This was a retrospective, single center, interventional case series performed in a tertiary eyecare center in central Medical records of consecutive cases of microcornea with coloboma who underwent pars-plana vitrectomy with phacofragmentation (PF) between January 2015 and December 2017 were reviewed. Results: The study group comprised of 30 eyes of 30 patients, of which 18 (60%) were males and 12 (40%) were females. The mean age of the patients was 41.9 years (range of 17� years). The mean corneal diameter was 6.7 mm with a range of 4�mm and all the eyes had dense cataract with nuclear sclerosis of grade 4 or more. The mean preoperative visual acuity was 1.97 (+/-0.067) Log MAR and the mean postoperative vision at 1 month was 1.6 (+/-0.39) Log MAR. Postoperatively, 21 patients (70%) gained ambulatory vision. The visual gain in all the patients was maintained over a mean follow-up period of 15.5 months. Conclusion: Pars-plana vitrectomy with PF can be considered in eyes with severe microcornea and brunescent cataracts, where cataract surgery through the limbal (anterior) approach is not only difficult but at times impossible due to anatomical restraints.
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AlM: To explore the clinical application effect of phacofragmentation combined with vitrectomy in the treatment of traumatic lens dislocation. METHODS:Totally 16 cases (16 eyes) of traumatic lens dislocation treated with phacofragmentation combined with vitrectomy were retrospectively analyzed, including 6 cases of high intraocular pressure ( lOP) and 10 cases of vitreous hemorrhage, and 1 case of retinal detachment. All patients were given conventional flat line standard three channel vitreous operation incision to remove the anterior, middle part and peripheral vitreous around lens dislocation. The crystalline lens were drawn to the center cavity of vitreous body and treated by ultrasonic disintegrator. ln the operation, the retina was examined and 8 of them had no retinal damage and in the first stage underwent fixation of posterior chamber intraocular lenses. RESULTS: All crystalline lens dislocated were completely grinded and suctioned. There was no retinal detachment occurred in 3mo followed up. 16 eyes had normal lOP (12-20mmHg) at 1wk after operation. The average visual acuity was improved and with 8 cases got improved of 0. 2 or more 1wk after operation. CONCLUSlON: Our research shows that phacofragmentation combined with vitrectomy is a safe and effective method for the treatment of traumatic lens dislocation. The patients with nondestructive retina in the operation are feasible to do first stage operation of intraocular lens suture fixation, which contributes to the best visual acuity.
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Purpose : To compare the effectiveness and safety of phacofragmentation and phacoemulsification techniques on senile white mature cataract. Methods : Prospective, double masked, randomized study comprises 32 eyes of senile white mature cataract randomly divided into 2 groups, 16 eyes had phacofragmentation (group I) and 16 eyes had phacoemulsification (group II). The evaluated safety parameters were pupil diameter pre surgery and prior to intra ocular lens (IOL) implantation, corneal thickness and flaremeter. Nucleus delivery, uncorrected visual acuity (UCVA) and surgically induced astigmatism (SIA) were the effectiveness parameters. Follow-up were scheduled for post-operative day 1,7,15 and 30. Results : prior to the surgery there were no significant differences in age, visual acuity, corneal thickness and flaremeter between two groups. Pre surgical and prior to IOL implantation mean pupilarry diameters in both groups were not significantly different. There was no significant difference in pupillary constriction on both groups. The mean of time to deliver the nucleus was significantly longer in the group II (4.38±2.51 min) than in the group I (1.98±1.61 min). There was significant difference on UCVA (p= 0.00067) and corneal thickness (p=0.0044) only on the first post-operative day. However, there was no significant difference on further evaluations (p>0.05). There were also no significant difference on flaremeter and SIA during follow -up. Conclusion : Both phacofragmentation and phacoemulsification techniques were effective and safe for cataract surgery on senile white mature cataract. Phacofragmentation technique therefore could be an alternative small incision cataract surgery.
Subject(s)
Cataract ExtractionABSTRACT
Objective:To evaluate the experience of perioperative care of phacofragmentation with vitrectomy.Methods:During 2000 to 2005,A group of 29 eyes in 29 patients underwent phacofragmentation with vitrectomy:Their lens nucleus were sank in vitreous cavity for different kinds of causes.The proficient nursing cooperation and perioperative care were retrospected analyzed.Results:The therapeutic effects after the operations were satisfactory.The post-operative best corrected visual acuities were between 0.1-0.5.No severe complications occurred.Conclusion:Right pre-operative instructions,sufficient preparation,and proficient nursing cooperation can ensure the success of the operation.
ABSTRACT
In order to evaluate the effectiveness and safety of intravitreal phacofragmentation, we analyzed cases of pars plana vitrectomy (PPV) with intravitreal phacofragmentation and scleral fixation of an intraocular lens (IOL) performed in patients with a crystalline lens completely dislocated into the vitreous cavity without any damage to the lens capsule. Of the 23 eyes examined, the dislocated lens was related with a hypermature cataract in 4 eyes and Marfan syndrome in 2 eyes, developed after argon and Nd:YAG laser iridotomy in 2 eyes, and was due to ocular trauma in 15 eyes. The dislocated lens was present for more than a year in 6 eyes and less than 4 weeks in 13 eyes. PPV, intravitreal phacofragmentation and scleral fixation of IOL were performed in all 23 eyes. Additionally, trabeculectomy was performed in 4 eyes, iridoplasty in 1 eye and cryopexy with intravitreal injection of sulfur hexafluoride in 2 eyes. Perfluorocarbon liquid was used in 9 eyes. The mean follow-up period was 11.7 months. On final examination, the visual acuity was better than 20/40 in 17 eyes (73.9%) and counting fingers in 1 eye due to traumatic optic neuropathy. There was no postoperative retinal detachment. These results demonstrated that PPV with intravitreal phacofragmentation and other combined procedures is a safe and effective surgical method for treating a completely dislocated crystalline lens.
Subject(s)
Adult , Aged , Female , Humans , Male , Lens Implantation, Intraocular , Lens Subluxation/surgery , Lenses, Intraocular , Middle Aged , Phacoemulsification/methods , Postoperative Period , Treatment Outcome , Visual Acuity , VitrectomyABSTRACT
We reviewed the records of seven patients who underwent pars plana vitrectomy and intravitreal phacofragmentation for removal of posteriorly dislocated lenses from September 26, 1994. to January 12, 1995. More than half volumes of crystalline lenses were dislocated during cataract extraction in four eyes, and all three eyes of dislocated lenses with intact capsules had a history of blunt trauma. Five eyes had visual acuity of 15/20 or better at 3 months after removal of intravitreal crystalline lenses. But two eyes, undergone excessive manipulation for removing intravitreal nuclear fragments via the limbus during cataract operation, had 4/20 vision with complication of retinal or choroidal detachment. These results suggest that the overall prognosis for visual recovery after pars plana vitrectomy and phacofragmentation for removal of intravitreal crystalline lens, is quite good if there were no excessive attempts to remove intravitreal lens fragment during cataract extraction.