Combined clear corneal phacoemulsification and transpupillary removal of silicone oil
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Combined clear corneal phacoemulsification and transpupillary removal of silicone oil. Y ü ksel Totan , Ramazan Ya ĝ c ı , Zeynel Arslany ı lmaz , U ĝ urcan Keskin The authors have no financial interest. Introduction.

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Combined clear corneal phacoemulsification and transpupillary removal of silicone oil

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Combined clear corneal phacoemulsification and transpupillary removal of silicone oil

Yüksel Totan, Ramazan Yaĝcı, Zeynel Arslanyılmaz, Uĝurcan Keskin

Theauthorshave no financialinterest


Introduction

  • Cataract is a frequentcomplication of siliconeoiltamponadeusedin themanagement of proliferativevitreoretinopathyandadvanceddiabeticretinopathycomplications.

  • Weaimed to evaluate clinical results of clear corneal phacoemulsification combined with transpupillarysilicone oil removal.


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.


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)


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.


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”


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


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”.


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)


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


Conclusion

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


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