VITRECTOMY TO REMOVE POSTERIORLY RETAINED IRIS EXPANSION RING.

PURPOSE: To describe management of posteriorly retained iris expansion ring-a newly reported complication of phacoemulsification surgery in a patient with intact posterior capsule. METHODS: Case report. PATIENTS: A 64-year-old monocular patient with history of regressed proliferative diabetic retinopathy after pars plana vitrectomy, long-standing glaucoma, and cataract, undergoing phacoemulsification for cataract removal, complicated by posterior migration of the Malyugin ring through area of zonular dehiscence despite intact posterior capsule, which resulted in significant visual disturbance. RESULTS: The intravitreal Malyugin ring was successfully removed by performing a standard 3-port 25-gauge vitrectomy and retrieving the mobilized ring into the barrel of the original injector device. CONCLUSION: A posteriorly retained iris expansion ring can be effectively extracted from the vitreous cavity with the original injector device, which allows for maximal control of the ring and minimal associated surgical trauma.

Spontaneous iris bleeding during cataract surgery in a patient with thrombocytopenia.

A 91-year old man with a history of senile cataract and chronic lymphocytic leukemia (CLL), with a platelet count of 75,000/µL, presented for phacoemulsification and intraocular lens implantation in the left eye. A paracentesis made at the beginning of the procedure caused a small but not unusual amount of anterior chamber decompression. Spontaneous bleeding subsequently occurred from multiple sights on the iris surface. The bleeding was stopped by injecting hyaluronic acid into the anterior chamber to increase intraocular pressure. The remainder of the procedure was performed without complication, and resulting visual acuity improved from 20/70 preoperatively to 20/20(-2) with refraction 1 week postoperatively. In previously reported cases of intraocular bleeding during cataract surgery in thrombocytopenic patients, platelet counts were all ≤55,000/µL.

Suction-based grasping tool for removal of regular- and irregular-shaped intraocular foreign bodies.

BACKGROUND AND OBJECTIVE: To describe a suction-based grasping tool for the surgical removal of irregular-shaped and nonferromagnetic intraocular foreign bodies. MATERIALS AND METHODS: A surgical tool with suction capabilities, consisting of a stainless steel shaft with a plastic handle and a customizable and interchangeable suction tip, was designed in order to better engage and manipulate irregular-shaped in-traocular foreign bodies of various sizes and physical properties. The maximal suction force and surgical capabilities were assessed in the laboratory and on a cadaveric eye vitrectomy model. RESULTS: The suction force of the water-tight seal between the intraocular foreign body and the suction tip was estimated to be approximately 40 MN. During an open-sky vitrectomy in a porcine model, the device was successful in engaging and firmly securing foreign bodies of different sizes and shapes. CONCLUSION: The suction-based grasping tool enables removal of irregular-shaped and nonferromagnetic foreign bodies.

Closed chamber pupilloplasty with an injectable shape memory alloy clip in enucleated porcine eyes in the laboratory setting.

A novel surgical technique and novel surgical instrumentation for closing a pupil defect in a closed chamber eye is described. The technique was performed in a laboratory setting using ex-vivo porcine eyes using a 30-gauge deployment system to repair iris defects. Given the difficulty of suturing in a closed chamber eye, the use of an injectable, shape memory alloy clip offers the advantages of rapid, easy deployment and increased strength over conventional suture techniques.