Combined clear corneal phacoemulsification and transpupillary removal of silicone oil

1. Combined clear corneal phacoemulsification and transpupillary removal of silicone oil Yüksel Totan, Ramazan Yaĝcı, Zeynel Arslanyılmaz, Uĝurcan Keskin Theauthorshave no financialinterest

2. Introduction • Cataract is a frequentcomplication of siliconeoiltamponadeusedin themanagement of proliferativevitreoretinopathyandadvanceddiabeticretinopathycomplications. • Weaimed to evaluate clinical results of clear corneal phacoemulsification combined with transpupillarysilicone oil removal.

3. Patients and methods • A retrospectivestudy • 20 patients; 13 males, 7 females • Agerange; 14-75 years, meanage 53 yrs • Thesamesurgeon(YT) performedalltheoperations. • Thereasonsforprimaryvitreoretinalsurgery: • Proliferativevitreoretinopathy in 13 eyes, • Retinaldetachmentwithgianttear in 2 eyes • Retinaldetachmentwithmacular hole in 1 eye, • Proliferativediabeticretinopathycomplications in 4 eyes.

4. Patients and methods • Type of cataract • Posteriorsubcapsularopacitiescombinedwithnuclearsclerosis • Biometry • SRK/T formulausingtrueaxiallength(AL) • True AL wasestimatedbymultiplyingmeasured AL bytheconversionfactor of 0.71 • Type of anesthesia • Topical (10 eyes), • Peribulbar (9 eyes), • General anesthesia (1 eye-14 yearsold)

5. Patients and methods • Surgicalsteps; • A superiorclearcornealincision • Phacoemulsification (quickchoptechnique) • Anteriorchambermaintainerplacementforinfusion • Posteriorcapsulotomy • Siliconeoilremovalthroughtheposteriorcapsulotomywith a 16 gaugecannulaconnectedto a 10 mL syringe • Retinalexaminationwith a wide-angleviewingsystem • IOL implantation in thecapsularbagorsulcus.

6. Results Visualacuity(BCVA) Aftervitreoretinalsurgery: Handmotion in 2 eyes, Fingercounting in 5 eyes, 0.05 to0.7 (Snellenschart) in 13 eyes Aftercombinedphacoemulsificationplussilicone oil removal Fingercounting in 3 eyes, 0.1 to1.0 (Snellenschart) in 17 eyes “Mean BCVA increase is 2 Snellenslines”

7. Results Opticalcorrection: IOL implantation in 18 eyes, 2 eyesleftaphakicaccordingtothepreopbiometry Typeof IOL implantation: Capsularbag in 12 eyes Ciliarysulcus in 6 eyes. IOL type HydrophilicacrylicmonoblocIOL in 14 eyes, HydrophobicacrylicmonoblocIOL in 4 eyes

8. Results Follow-upperiod: Mean, 12 months(range, 4-36 months) Postoperativerefractiveerror (sphericalequivalent): Themeandeviation,-1.0 ± 1.84 D (range, +2.0 to-5.0 D) A total of 90% waswithin± 2 D 45% had a deviation of ± 1 D “No significantsurgicalcomplicationleadingtodecreasedvisionwasencounteredduringthefollow-upperiod”.

9. Discussion Cataract is a commoncomplicationfollowingvitreoretinalsurgerywithsiliconeoiltamponade. Combinedphacoemulsificationandsiliconeoilremovalthrough a clearcornealincision has someadvantages : Reducednumber of surgicalprocedures, Reducedoperation time, Lessor no posteriorpressureduringphacoemulsificaiton, No sclerotomy, No posteriorcapsularopacification, Reduced risk of retinaldetachmentandvitreoushemorrhage (Because ora serrata is spared)

10. Discussion Somepotentialdisadvantages of combinedsurgery: Lesspredictablepostoperativerefraction, Increaseddifficulty of in-thebagIOL implantation (particularlyfor mono-blochydrophilicIOLs), Relativehypotonyaftersiliconeoilremoval, No chance of membranepeelingorretinalstabilization. Potentialsubluxation of the IOL in case of inadvertentlargeposteriorcapsulotomy Angiographicmacularedema

11. Conclusion Combinedphacoemulsificationandsiliconeoilremovalthrough a clearcornealincision is a safeandeffectivetechnique, but must be reservedin selectedcases in which retina is permanentlystabilizedwith no significantepiretinalorsubretinalmembranes.