Twenty-nine-gauge dual-chandelier retroillumination for the non-open-sky continuous curvilinear capsulorhexis in the penetrating keratoplasty triple procedure.

We describe a technique for the penetrating keratoplasty (PKP) triple procedure that uses 29-gauge dual-chandelier illumination during creation of a non-open-sky continuous curvilinear capsulorhexis (CCC). The chandeliers are inserted through the pars plana into the vitreous cavity through the bulbar conjunctiva at the 3 o'clock and 9 o'clock positions. We compared this approach with that of a core vitrectomy, in which a single 25-gauge port is inserted into the vitreous cavity transconjunctivally through the upper temporal pars plana. The area of halation around the corneal opacity was significantly smaller in the 29-gauge group than in the 25-gauge group. The reduction in halation improved visibility of the anterior capsule and enabled the surgeon to perform CCC with greater safety. The 29-gauge chandelier system was more suitable than the 25-gauge chandelier system for the non-open-sky CCC component of the PKP triple procedure.

Efficacy of chandelier illumination for combined cataract operation and penetrating keratoplasty.

PURPOSE: The aim of this study was to describe a method for non-open-sky continuous curvilinear capsulorhexis (CCC) with chandelier retroillumination for penetrating keratoplasty triple procedure and report its effectiveness in decreasing intraoperative complications and enabling successful primary intraocular lens (IOL) insertion in patients with moderate or dense central corneal opacities. METHODS: Seventeen eyes of 17 patients were enrolled in this study, divided into a chandelier group, including 7 eyes of 7 patients, and a nonchandelier group, including 10 eyes of 10 patients. In each group, time to achieve CCC (in seconds), open-sky time (in seconds), and operation time (in minutes) were measured, and the rates of successful CCC completion, rupture of the posterior capsule or zonule of Zinn, and successful IOL insertion were recorded. RESULTS: CCC time was not significantly different in both groups. In the chandelier group, however, open-sky time and operation time were significantly shorter than in the nonchandelier group (1429 ± 67 vs. 2016 ± 354 seconds, and 90.4 ± 3.5 vs. 108.9 ± 10.3 minutes, respectively). In the chandelier group, the rate of successful CCC completion was significantly higher than in the nonchandelier group (86% vs. 30%). The rates of posterior capsule or zonule of Zinn rupture and successful IOL insertion were not significantly different (14% vs. 40%, 14% vs. 10%, and 86% vs. 70%, respectively). CONCLUSIONS: Non-open-sky CCC with chandelier illumination has many advantages for penetrating keratoplasty triple procedure compared with open-sky CCC without chandelier illumination.

Combined 25-gauge microincision vitrectomy and toric intraocular lens implantation with posterior capsulotomy.

PURPOSE: To evaluate the efficacy of combined 25-gauge microincision vitrectomy surgery (MIVS) and toric intraocular lens (IOL) implantation with posterior capsulotomy. METHODS: Noncomparative, interventional case series performed at a single center. Twelve patients with vitreoretinal disease and cataracts, with preexisting regular corneal astigmatism greater than 1 diopter, underwent 25-gauge MIVS and toric IOL implantation with posterior capsulotomy. RESULTS: The toric IOL was successfully implanted in each case. At 6 months postoperatively, mean axis rotation was 5.7° ± 3.1°. At 1 month postoperatively, mean uncorrected and best corrected visual acuity improved; the improvement was maintained after 6 months. The absolute residual refractive cylinder was significantly lower postoperatively than the pre-existing regular corneal cylinder (P = .003). There were no surgical complications except temporary posterior iris synechiae in one case. CONCLUSIONS: Combined 25-gauge MIVS and toric IOL implantation with posterior capsulotomy is a practical and safe method to treat vitreoretinal disease and cataracts with pre-existing corneal astigmatism.

Difficulty in inserting 25- and 23-gauge trocar cannula during vitrectomy.

PURPOSE: To determine the incidence of difficulty in inserting a 25- and 23-gauge trocar cannula (DITC) during 25- or 23-gauge micro-incision vitrectomy surgery (MIVS). METHODS: Retrospective, consecutive, interventional case series performed by a single surgeon at a single centre. We defined a DITC as the condition where at least 1 trocar cannula could not be inserted into the vitreous at the beginning of MIVS. The incidence of DITC was calculated from 1,525 eyes, and the pre-operative demographics of the DITC cases were compared to those of the non-DITC cases. RESULTS: The incidence of DITC for all cases was 0.6% (9 of 1,525 eyes). Overall, there were 242 eyes with a retinal detachment (RD), and 8 of the 9 eyes with DITC had an RD with an incidence of 3.3% (8 of 242 RD eyes). Seven of these 8 eyes had a total RD, 4 also had a choroidal detachment, 4 eyes were also myopic (>-8.0 dpt, high myopia), and 6 of the 8 eyes were hypotonic (<8 mm Hg). The DITC cases had larger RDs (p<0.0001), a higher incidence of choroidal detachment (p<0.0001), higher myopia (p=0.0204) and hypotony (p=0.0003) than the non-DITC eyes with an RD. CONCLUSIONS: A large RD, a choroidal detachment, high myopia and hypotony are significant risk factors for DITC. We recommend that MIVS should be performed cautiously for eyes with these risk factors.